given that platitude. >> you're going to forecast, great. >> the gentleman did ask for time. >> i just wanted to point out i know you said before these were special deals that were in order to obtain members' votes -- i think that's -- it may have been true when the bill passed the senate. i'm not been to argue that but what i would like to stress is i think what my colleagues like to point out is we were very careful when putting the reconciliation package together to review those and the only cases now where a state for example we see in our tennessee that you mentioned is getting some different treatment i would oppose special treatment is because it's justified in terms of a good government analysis, not because we are trying to obtain someone's vote as in the case of nebraska. so with the case of louisiana other ones like nebraska were

eliminated. louisiana was not because you had hurricane katrina and it was justified under the circumstances because the loss of medicaid funds and would apply to anyone else who falls into that category in the case of the disaster. and you also mentioned tennessee and it's true that in the bill you have tennessee and hawaii are the only two states because they don't have an allotment of the federal medicaid disproportionate share or dish funds they are getting some additional help but that's because they have no funds under dish and they needed to pay for their safety net hospitals that they have so what i would try to say to you is there may be circumstances where one state is treated differently but it's not in an effort to obtain votes which may have been the case on the senate side. it's an effort to correct that and do it based on a good government analysis of every case and i think that's a fair way to look at it rather than, way to look at it rather than, you

different in this respect it's not because we are trying to get anybody's vote. >> so in other words the good government bill probably will not ever become wall and the bad government if we were to turn around the bill -- >> i'm seeing that these reconciliation amendments -- >> the good government bill becomes law we once you pass the reconciliation amendments, yes and eliminates -- eliminates some of the problems that you're citing that were based on someone got a special deal because they wanted it. >> that would then probably become law. i would like to go, and i mentioned i had three things i wanted to talk about. i would like to go to the next subject if i couldbly mr. runyon perhaps he would recognize this and i will make this available to the clerk said that each and every one of the panelists can have a copy here

but there is been a discussion -- unsury, on the panel but if others need a copy i would be glad to make them available. but there is talk about the lifecycle or extension of the lifecycle on medicare that the gentleman mr. waxman's the success began solvency. >> the gentleman has related about how great this samet bill ase i assume we are talking about related to the solvency. does mr. ryan have a comment? i know these are probably -- >> this spreadsheet is a coverage spread sheet but that's not the medicare numbers. but if you look at the letter i got from the cdu yesterday which i inserted in the record earlier this morning, page four, let me just quote for you to congressional budget office rolling so to speak on whether or not the medicare cuts in this

the extent solvency. in effect, and i'm quoting here in effect the majority of these trust fund savings under h.r. 3590 and reconciliation proposal would be used to pay for other spending and therefore would not enhance the ability of the government to pay for future medicare benefits. but pretty much makes the point right there which is you can't count money twice. either you're taking $523 billion out of medicare providers and what ever you are doing and it's going toward solvency or you are using it to create this new entitlement program. not both, it is 1 dollar comes into the government and it goes one way or the other, it doesn't go to ways to reverse a $523 billion are coming out of the medicare program to fund the new entitlement and the cbo certified it as recently as yesterday. >> can i respond to that? i would like to respond to that in a very general way and it's my philosopher the whole way we

are doing today and tomorrow. you said we can't count things twice. you talk about cbo. i did you can count things many times for the following reason. the cbo takes no consideration from the overall impact of this bill from a preventive perspective. in other words, all i believe and there are many commentators out there beyond the cbo that say because what we are doing in this bill, covering everyone, filling the doughnut hole, letting people get primary care, the amount of savings to the government in the system over the long term are going to be trillions and trillions of dollars beyond what the cbo estimates because people who don't get their drugs now because the meat the bill not whole problem or people that don't have insurance and don't go to a doctor on a regular basis or people that don't get preventive care because of a co-payment because we remember we eliminate co-payments for

preventive care. all of those things are going to mean people get to see a doctor, get their drugs, get the medication on a regular basis and over the life of this program you are going to save millions of dollars to medicare, medicaid, federal government, to the system as a whole. so i understand when you're trying to say you can't count twice. i think you can count this two, three, four times because of the impact to the system and the amount of money we are going to save and cbo will never score that. >> so i would just say to the gentleman who i don't know if he was up here when we went through the stimulus bill but i asked the question to the gentleman mr. rangel what kind of things would happen and he told me mr. sessions with the matter of months you will see millions and millions of jobs created in this

country. i hope you are better at kissing that they mr. rangel because he came without anything to support that theory. i would like to go to as part of that than the uninsured. we have heard about how everybody talks about everybody is going to be injured. we heard mrs. slaughter mengin 95%. it looks like a round 2014 all the 31 million people uninsured and about 23 million uninsured in 2019. can anybody accurately discuss who those people are? >> this coverage question about those eligible, essentially it would be people eligible to enroll but who do not. >> it was on the sheet of paper i passed out.

>> first of all i'm assuming your question excludes the undocumented because as you know they are not covered by the bill. >> i would say as best i could tell you i was looking at this sheet of paper. i don't know -- >> here is what my understanding is. akaka citizens undocumented people each of them is not all will do good vantage of that opportunity just like there is universal free public education but also in truancy. this is the cbo best guess as the number of people who have the opportunity to enroll but. the fact of the matter is under this bill banning the senate bill and reconciliation bill every person who is either a citizen or a legal resident of the united states will have the opportunity to obtain health

insurance 100%. >> mr. sessions if i may. the point you're trying to make is while this is claiming to be universal coverage you will have a population the size of texas floating through the country on the injured even after spending trillions of dollars, subsidies, taxes, mandates, government bureaucracy and that will still try to get emergency room costs, health care costs, still be the payment shifting and major burden on the united states and however you tend to describe it clearly what we saw in massachusetts when they sought universal coverage was a higher premium cost, higher government spending already after two and a half years they started to ration care at certain hospitals and certain population groups just in two and a half years bissell the results of that answer that is the concern they are not only not covering all americans clearly but they are also driving those costs up for those who have health care.

>> rationing care, where does that happen? >> we already began four months ago limiting payments to certain hospitals within massachusetts and cutting benefits. >> -- is not perfect but the goal to insure -- >> does massachusetts have the highest health care premiums in america today? >> i don't think so. >> it does. has already begun cutting payments to -- >> while we are paying -- what we are paying for health insurance -- people paid their own health insurance in massachusetts are paying for health insurance and those in texas -- let me finish my sentence please. we in massachusetts have attempted universal coverage. everybody should have health care. people are paying for health care in massachusetts but we are also paying for people in texas, people who may be able to afford insurance who choose not to get it who get sick and good to the

hospital and that is all uncompensated care and we pay for it. one of the ways to control health care cost is to make sure people have coverage. one of the reasons that it's difficult for us to be able to control health care cost as much as we would like is we are paying for people in your state who don't have coverage. seabeck so you're saying -- so you still have the highest health care premiums in america. there is cost shifting from the government to the private pay and then finally has health care spending been reduced to massachusetts as the result of the plan? >> the plan is working. it's not perfect but we that it works if everybody else in this country every other state come in your state has one of the highest uninsured populations -- >> i would be embarrassed if i had the highest health care premiums, too. the answer is yes they do have the highest premiums. we will see the same. [inaudible conversations]

>> there is a lot of plans that could be made here. a the only thing i would see is when given an opportunity the people of massachusetts, i think they voted overwhelmingly across the state to elect a person who would come to washington to oppose that great plan that might be same or similar. >> of the gentleman will yield the senator voted -- >> mr. sessions, mr. brown voted for the massachusetts health care plan. >> to not replicate anything. >> what the gentleman yield? >> i would yield to the gentleman from north carolina. >> i want to just add a point about what my colleague mr. sessions is saying that there is an article in the "boston globe" on wednesday, quote stage treasurer timothy hill of massachusetts saying if president obama and the democrats repeat the mistake of

the health insurance reform in massachusetts on a national level they will threaten to wipe out the american economy within four years. then he goes on to say that it's time for the president and democratic leadership to go back to the drawing board and come up with a new plan that doesn't threaten to bankrupt the country. so i think there are people who share the same concern, mr. sessions, who lived in massachusetts and served in public office. >> with the gentlelady yield? >> it's not my time. >> i want to say i think the majority of people in massachusetts would not want to repeal the health insurance system that we've put in place. i also point out that same health insurance system was voted in favor of bye senator brown. the other thing in terms of cost our costs have risen more slowly than any other state in this country. if we can get a comprehensive plan in place it will save us

from paying for the people in your state can afford insurance who choose not to get it and when they get sick we end of having to pay for it. >> when you're talking about the people in massachusetts pay for texans who choose not to have coverage because we have higher rates of uninsured -- >> when talking about is when people go into a hospital without insurance, it costs money. it is uncompensated care to read and the uncompensated care whether it is in texas or anywhere else, someone pays for it. who pays for it? we pay for it in the form of federal taxes. we pay for it because we don't pay for goes on the debt and we pay for on the interest of the debt. so the uncompensated care in this country is one of the reasons we see the deficit's going out of control. so we are paying for your state, mr. sessions, for being one of the worst states in the country -- >> we are reimbursing then why

are so many people going through bankruptcy of somebody paid the bill? >> [inaudible] >> but who did? >> they put on their credit card because they didn't have any insurance, they ran up their credit card and they are into bankruptcy, uncompensated care that is added to everybody's premium in this country. >> i believe that. >> that is why businesses are dropping insurance and people come to washington from large and small business and tell you" e

uninsured today. and we are talking about why did the first three years i believe cbo bears this out, 5 million more jobs to pay for this, didn't probably which bill you go for mr. perlmutter, whether one or on the house side another, what i'm saying is 3 million will take your figure. 3 million people are going to lose their job to take care of 27 million people who then will be covered. and i think that is a horrible way to look at how you balance out this big effort and what we are trying to do. i was led to believe -- i appreciate -- >> 10 million uninsured at the end of the decade under your proposal. >> and i appreciate that help, mr. miller but the bottom line is we are talking about your to bills. and george to bills we've been selling out there we are going to take care of everybody. but what we are doing this for

is about 27 million people, and three more are going to have to lose their job and are going to put this huge system on top of everybody. >> would the gentleman yield? >> i would yield to the gentleman mr. pallone. >> i know you've got these figures in your mind about -- >> they are right here. >> i understand what i would point out, when you are going to cover all these people and they are going to have to -- they are going to primary care and are going to see a doctor, they are going to be a lot more health care professional jobs to take care of all of the primary care to deal with all of these people now health insurance and i want to respond with we yield to dr. fox because the bottom line is you suggested that we are headed towards bankruptcy or whatever. that is what is happening under the status quo. the status quo more and people are not we do have insurance. premiums are going up 20, 30%. the percentage of the gross national product is devoted to health care and keeps climbing. it's twice what it is in any

other developed country. if we don't do me anything i have no doubt we are going to be bankrupt but here we are proposing a very rational way of trying to corrupt the system and put a lot more people that would eventually be injured and give them insurance to try to control these increases and not have a 20 or 30% increase like we are seeing now and covering everybody. so i just don't understand. i don't mean to be disrespectful but it's almost like you say the status quo is acceptable and things are going to get better on their own. they are not, they're going to get worse. >> reclaiming my time -- >> you may not think this is a perfect solution, but it is so much better than the status quo. it's just so much better. >> i appreciate the gentleman but nobody is suggesting status quo. not one person here. i am simply saying i don't think that -- >> if mr. sessions would yield.

>> [inaudible conversations] >> i want people to stop talking over each other. it's always been polite appeared. this is the only committee as we know that goes on forever. [laughter] we would like very much -- we would appreciate very much if you would limit yourselves to some degree because we have a very long and heavy day ahead of us. but please, ask for and receive the ability to speak before you all start talking at once. mr. sessions. >> i agree. thank you. reclaiming my time. the last issue i wanted to get into is directly related to the physician reimbursement called sgr. and i am aware that we had a 21% cut that took place in march. i know that was about another 280 billion-dollar fixed is already in place. we are seeing a number of

physicians that are deciding they will not take care of medicare patients as a result of this. we now if you add the 21% and try to fix what ever we are told a might be, $523 billion instead of $280 billion. it is not in the bill would it is a cost to the system. and i am concerned that we are not right sizing this mr. hensarling, you've been through this in the budget committee. i would appreciate your take on that. >> i thank the gentleman for yielding. i listened carefully to the gentleman from new jersey and i'm glad he is concerned about the nation going bankrupt which makes me question why would you want to enact a policy that simply stamps on the accelerator towards bankruptcy. i know that earlier today many people on your side of the aisle are waiting around a congressional budget office

letter talking about we're going to save money. we are somehow going to reduce the deficit through these policies. cbo is made up of crete professionals but the only estimate or as we call it score was before them and guess what if you don't put before them the dak fix they don't score it. now already the speaker of the house has said there will be a doc fix physicians will not receive a 21% pay cut on medicare reimbursements. the speaker said the that on the record. so the ranking member of the budget committee mr. ryan of wisconsin asked the cbo okay the speaker said we are not going to have 21% pay cut and i will read from this letter i trust that it's already been entered into the record but it's a letter dated march 19th from the congressional budget office to the honorable paul ryan, and i

will read the operative language. quote, you ask the total budgetary impact of enacting the reconciliation proposal. the senate passed a health bill and the medicare physician payment reform act cbo estimates that an acting all three pieces of legislation would add, i emphasize the word had $59 billion to the budget deficits over the 2010, 2019 period. so i have my own a letter from the congressional budget office and frankly this is as the gentleman from texas knows is just one of the many budgetary gimmicks that are being used, and i sure people's hearts and minds are pure and clear but they are accounting would mcburney madoff blush. we are talking ten years of revenues matched against six years of program. every single decade is the

democratic majority in tandem turning off this program? for four years after this year than are you going to have you're 21, 22, 23% pay cut for doctors under the medicare system? for clamming medicare savings twice on your revenue side. you're claiming 520 billion in medicare cuts, 210 billion in medicare taxes, but this is double the counting. you can't have it both ways. either the money is used for the solvency of the medicare system where it is being used for your new entitlement. that brings us to the class act, the new in title mind that you are putting into this program. five years of premiums, $70 billion that he were taking out of your brand new entitlement to do is to reduce the cost of this. so are you going to pay it back? even the democratic head of the budget committee said, quote, this is a ponzi scheme.

this is the democratic chairman of the senate budget committee describe this scheme as a ponzi scheme. reeds on social security. $53 billion in new social security revenue to achieve the appearance of deficit cuts but they are not really there. are you saying that you're going to permanently take this money out of the social security trust fund and not replace it? i mean, that's going to reduce the deficit and on most to own up to the fact 21% of the medicare system to create a new entitlement yet you're not going to fund, yet again raise the social security fund a and not replace that revenue. again, it's just not realistic. and the doughnut hole. the doughnut hole doesn't get scored until the next decade.

it is totally unrealistic. again, casting no aspersions on the congressional to office, but the score was in front of them. i could go to the congressional budget office and say i want you to score the hensarling family health care plan and i want to assume i don't get sick the next ten years and we're putting our children up for adoption. can you give me a number? one assumption is false and the other assumption is totally unrealistic. so cbo will score was before them. now that the speaker said on the record there will be a doctor fix you can't count 21% pay cut, thus congressional budget office says that you are making the deficit worse and you are hastening of the road to bankruptcy. ..

>> the cbo looked at the full 20 years, and he said that the deficit will be reduced by between three tenths -- i put three tenths and five tens of gdp, about $1.2 trillion over the 20 years that that was what was before them. that's what they concluded. and you just can't say we believe them when we like what they say, and we don't believe them when we don't like what they say. that's what they said.

>> are you suggesting then that in the number that you're talking about, that the doc fix of -- >> no, sir. i did not say that. >> this goes back to my point, that we're looking at a system today that's got to be reformed. >> does the gentleman -- >> of course i support the doc fix. >> how would the gentleman would the gentleman pay-fors? >> let's just go to, i think you ought to pay for a. >> how? >> you know what? we could do that just fine and we will do it next year when we're in the majority can. you just watch out. >> will the gentleman from new jersey you'll? >> i sure will. >> i know it is $580 billion, or 523 billion, because we're taking it and spinning it somewhere else. it's a matter of priorities. and what we're essentially doing it for is this 25 or 26 million people, but still living 23 that are not served.

and this is where it goes too. the entire system, the entire system, rob, is -- >> would the gentleman yield? >> i will. i gave the gentleman time. i am saying to you, the entire system could collapse to cover 25 million people. and the entire system, everybody, could collapse if we really add it all into good. and the gentlemen does -- >> will the gentleman yield? >> i will yield to the joan. >> the gentleman says he supports the doctor fix. which is why the american medical association said very positive things about this bill. there's three ways to pay for the doctor fix. you can find spending, or you can adjust the bass line and pay for it that way which is what the present budget resolution does. which of those do you support? >> here's what i support. i support being honest and recognizing that maybe the ama says it's okay to take out the

21% but not one position i talked to is in favor of that. and that they will quit doing business for our senior citizens and we're not doing anything that i consider to be worthy to avoid that circumstance. and i'm simply saying, you know, you have to evaluate what's in front of you. my evaluation of what's in front of me is 19 it all out, netting it all out. we're not going to buy the doctors. we still have $523 billion that the gentlemen, mr. hensarling, by the way, madam chairman, i would like to ask unanimous consent, the letter he read be include in the transcript. >> without objection. >> we are going to not even put in $523 billion of cuts. >> would the gentleman yield one more time? >> and that is a bad proposition to lend 3 million more jobs to

get to there. i would. >> i support that we should not expand the system, that we should have more people pay for this system. you know that republicans would have that come from court reform. i think that we ought to -- it would be in there if we don't grow. >> with the gentleman yield? >> my point would be -- i hope this has allowed ever bought an opportunity to have a full dialogue. >> i am going to be very brief. i listened to what he said.

based on what we gave them, they said that this reduces the debt significantly. the republicans, when they did the dr fix, they did not pay for it. now, you know the republicans in the past when they did the doctor fix them they didn't pay for it that it wasn't paid for. there's no reason to believe it's going to be paid for. the iraq war wasn't paid for. so many other things were not paid for. i think it's very unfair, i don't know, they been that's not the correct word, but it's inaccurate or somehow unfair for either of you to come here today and say what about the doctor fix, or i can take what about the war, or what about this? the bottom line is, we're not voting on the doctor fix today. if we vote on then it has to be paid for or it will be deficit reduction. the same thing with the iraq war, the same thing with all these other things that being passed without attention to the

deficit. the bottom line is this package which we're asking you to rule on is a significant reduction in the deficit. and it is completely paid for. so i just think, you know, i've been trying to say from day one here that the cbo is a very artificial construct. there's no question it is. i consider today include you we're going to save trillions of dollars beyond what the cbo says, just because they don't have preventive care and the fact that so many people are going to be able to see a doctor and not end up in the emergency room. you can do whatever you want but the rules are we've got to use the cbo and this is what the cbo says that we're touting the fact it is a major deficit reduction, because within the confines that you and i and all of us agree on, this is a major savings for the federal government over the lifetime of the program. >> i appreciate that, mr. pallone. but you've argued both sides, but you're not including the whole costs. >> i said he when you're in a majority for 12 years, and i'm not being disrespectful.

but the whole time you passed all these things on a didn't do any tension to the deficit. >> we were running $200 billion deficits a month. >> it's clear that doctors fix is not going to be -- >> off the surplus. >> you know and i know what. >> i appreciate that. >> i just wanted to point out that we did offer a proposal on the floor during the debate on this health care bill that would update the doctor payments for four years at a 2% increase. it was fully paid for. so the concept that we've never tried to pay for the doctor fix is just absolutely wrong and i want to correct it. we did pay for the updates when we are in the majority. that was -- is absolutely wrong to say we didn't pay for updates in the doctor fix. cbo says that if you include the cost of doing that, the deficits going to go up and that's not even including the real cost of long-term care insurance. the real cost of the 10 billion that we know irs is going to

have to have to enforce the provisions of this bill. so there's a lot that's not in the cbo score, but we do have a letter from cbo saint if you just include that one thing, you increase the deficit. >> in other words, this new 16,000 employers in the irs that will take to come after this, they aren't included in this bill? >> no, that's not include. >> oh, my gosh. >> if you cut $500 billion from medicare, and you don't do the doctor fix, how are you going to keep physicians receiving medicare patients? you're not. you're not fixing -- you're not doing the doctor fix that you're cutting 500 billion from medicare. in fact, you are double counting as my friend hensarling mentioned. you're not going to keep them covering seniors, and that's a concern that really needs to be addressed. >> maybe that's how you pay for the built-in. mr. hensarling i know has been after me, and very polite and i appreciate my friend putting up with me.

>> well, i well, i thank the gentleman for yielding one more time. i would say to my friend from new jersey, this friend from new jersey, number one, the assumption you make on 20 years still include the double accounting on medicare. you're still claiming 520 billion in medicare cuts, 210 billion in new medicare taxes that you're using twice. wants for the solvency of the system, and the other to pay for this. and again, you can't have it both ways. the cms chief actuary has written quote in practice the improved hifi nancy cannot simultaneously used to finance other federal outlays, such as the coverage expansions. and to extend the trust fund despite the appearance of this result from the perspective accounting privileges that i would say to my other friend from new jersey, again, what you put before cbo, yes, they will score, but to go around and try to entice members to vote for

this bill, when you have assumptions that are simply not true, i just think is undeserving of the process of this house. i would also point out to this friend from new jersey, since i have several friends from new jersey, the congressional budget office, it says, itself says that in the out years -- [inaudible] [laughter] >> that in the out years, that their estimates become even more unreliable. and i think we know through history that the predecessor to the congressional budget office, when they were asked to score the 30 year cost of medicare, were off by a factor of somewhere between 801000%. so this new entitlement saves money, it will be the first entitlement in the history of mankind that actually produce to save money. and frankly, it just defies

common sense and logic that you going to bring in 30 million some odd new people into the health care system, half of which will be on medicaid and at the end of the day somehow you're going to end up saving money. you may have convinced yourself. it is clear you have not been this the american people. >> i'll be brief because we need to move on. i just want to codify something, mr. hensarling said. i do speak louder. how about now? i just wanted to comment on something mr. hensarling said because i think you can go without saying, we can have our numbers come we can have our charts. we can talk about rejections, but if we can have an arbiter of what is the most accurate, then we're nowhere. it's a food fight. and the reality is here, each of us, republican and democrat, have relied for more than 30

years on the congressional budget office. whether they are always right on the number, or a little off, we rely on them because we know they are not partisan. we know they are not biased. we know they're independent. and if we can't trust them, then all bets off because there's no one we can trust. and so i was and they say to mr. hensarling. for mr. hensarling to say that the numbers are not real is to impute the reputation of the congressional budget office. >> i'm going to reclaim my time because i do believe mr. hensarling was saying that at all. >> he was saying it was not in the. >> mr. sessions, if i could clearly say this. let's understand that the congressional budget office isn't a child. when they go through and scrub all these gnomes, they make sure that they are not being hoodwinked by unix and shell games. so they came up with the snow was. not republicans, not democrats but we should be able to move forward and understand what the cbo is giving us.

i thank the gentleman for yielding. >> i would like to be extended to additional minutes. mr. hensarling for one of those minutes, please. >> i trusted you know. i do not trust the assumptions you gave cbo. >> mr. dreier? >> thank you very much, and let me just say that i think that what we have with this here again underscores a need for an open rule and a debate on house floor. i have listened to mr. pallone, and almost a daily basis i listen to mrs. slaughter, mr. mcgovern and mr. hastings. regulate point to the horrible things that we did as a justification for the action that is about to be taken, whether it is using this process, which would use with great regularly, whether it's all kinds of things. and i'd like to just share with our colleagues again, the fact that when they now majority came to majority, it was the process

of campaigning, they did so in large part attacking us on our record. and there was a document called a new direction for america. and this is what speaker pelosi ran on in a new direction for america. and i just like to share with our colleagues a couple of brief paragraphs from this item. the bills should come to the floor under a procedure that allows open, full and fair debate consisting of a full amendment process, that grants a minority a right to offer its alternatives, including a substitute. members should have at least 24 hours to examine bills in conference reports text prior to floor consideration. rules governing floor debate must be reported before 10 p.m. for a bill to be considered the following day. house, senate conference committees should hold regular meetings at least weekly of all conference committee members, all duly appointed conferees should be informed of the schedule of conference committee activities in a timely manner

and given ample opportunity for input and debate as decisions are made towards the bill language. and the fact is, i mean, we regularly hear that we did something that is being done now, which was harshly criticized. and the promise that was made in a new direction for america was, in fact, these things are being subverted now. i asked about the conference. mr. sessions, just yielded to me. and i do know that you will of course be able to point to something that we did eight years ago they didn't exactly comply with what was put forward here in a new direction for america by ms. pelosi. so i would just like as we look at what's taking place here at this moment, say that an open and free flowing debate on the floor of the united states house of representatives is with the american people deserve, and that's what we should be doing right now. >> i appreciate the gentleman. mr. chairman, thank you today

and to the gentle woman, mrs. slaughter, for making sure that each of these memories could be here today. they are taking a lot of their weekend to come up and provide testimony. i have found it very insightful. i do have friends from new jersey, a place i used to live and i enjoyed new jersey. but i think it's important that every time we do a major bill, that we have experts, people who understand the bills which has not been the case, or able to come here, answer questions that i know you're counting votes that i'm a noble. i yield back. [laughter] >> i was going to put you as undecided. >> i think this panel has been terrific. i just want to say one thing in response to my friend, mr. dreier, and that is we are faced with a competent process today because members of your party in the senate have said that they will filibuster the appointment of conferees.

we go to conference. i mean, we can't get around it that you need 60 votes. and they won't even allow us to have a vote, up or down on this pic and so you know, i wish things were different but i will tell you, you know, with respect, members of your party have made it very, very difficult by throwing roadblocks at every chance they get to try to prevent us from moving this forward. >> will the gentleman yield? >> i want an up or down vote. it is very, very difficult. i yield to the gentleman. >> if we've had the democrats in the senate four years blocking our proposals for associate health plans, for our proposal to bring about reform. they chose to do that and we could have played a bigger role in driving the cost on health insurance -- no, it's not payback at all. is simply recognizing that the idea of a 1.2, and it is a $1.2 trillion program that

involves the federal government more heavily in health insurance that has ever been a before is not the answer. that's what mbs of the senate are saying, we say the exact same thing. i thank my friend for yielding. >> i will yield to ms. matsui from california's. >> thank you very much. mr. chairman, i'm very pleased to be a. i know all of you are pleased to be here. and we should get some better cushions for your chair there. i should say this is an interesting time, and i have not been here for six, eight, 20, 30 years at all. but i am here now. and i am privileged to be here now, to participate, especially this great bill. i mean, teddy roosevelt i guess it started this process. so it's been republicans and democrats. and i don't know when teddy roosevelt was president, must have at least 100 is ago, but we have been through this where we all, as americans, felt that it

was time time to provide for our citizens, time to provide citizens. and we go uphill and downhill. we go up, we come down. we're doing this again. we are at this crest now. we can almost get there, almost get there. and we could just bring up the pass as much as we can't about you did this come you didn't do this and all of this pic i think we all agree that we've done we all agree that we've done things,@@@@

notes to you. people do right notes, you know. the ones who called. and, you know, their stories are very similar to all of ours, too. and i think each one of us, despite the great health care we have, always know that there could be the next thing there. that could really wipe us out. that's over talking about here. we are talking about taking care of each other here. and that's really an american tradition that and i think it's time we move on it. now, i understand that this is a difficult comprehensive bill. it is. i sat in the energy and commerce committee hearings and subcommittee meetings and everything else, hours and hours and hours. and i think all of you did, too, and labor and ways and means and everywhere else. and in discussions, town halls, talking with your friends, we've done that. we discussed all of this.

it's really time to do this now. and i must say that i think each of us have the best intentions here. but we cannot just are pulling this thing apart, because we know why it's hard. it's a very complicated, comprehensive system that really does touch all americans. and want to ensure that all americans can be covered in some way. and we also our free market society, so we also realize that we have a plan already as far as our private insurance and how we do things. we haven't medicare that we have a few things you. but as far as putting it together we have not done that. so it's really time to do that. now, we can do all the good stuff and just say, let's just get rid of preexisting conditions. let's go ahead and just get rid of lifetime caps and all that. you can do that in isolation. we absolutely cannot do that in

isolation. if we could, we could have, we would have done that already. we get to the. so what we need to do is look at the whole picture. and i think i read in one of the articles that you look at health care like a three-legged stool. you know, if you just had one leg on it you could barely balanced, maybe for a while. you have to let judges to a certain a certain way. three legs, you are finally pretty much balanced out. and that's what we're talking about about this system. so i think it's important for us to look at the fact that this is something that the american public, and i for from the american public, too, most of them understand that the system we have cannot go on the way it's going. they are a little afraid. you can understand that. change is difficult. but we're trying to do this in the most reasonable way, with what they know are familiar with already. they can keep their doctor.

many of my senior citizens, can i keep my doctor? yes, you can keep your doctor. we understand how important is to have your doctor and we understand how important it is to have a coordinated care so you don't have to keep taking all these tests over and over again. we have address a lot of these things, and that is what it is a complicated system. so i think that it is something where we have looked at. we want to make sure it is affordable for all middle-class americans because they're being challenged the most. we know the insurance companies have been given their free ride. so we hold them a couple. and we want, you become have accessibility for those who don't have it right now. those are the principles that we built this upon. now, i can't see us pulling this thing apart right now. we have gotten this far. i know there are challenges ahead here. but anything this big is going to have been taken this long, and when we make policy and we tried to get it to the floor, we

know it's not the most simple way at all, but this is not a simple situation at all. this is almost the last thing we can do right now for all americans. we'd like to do it. now, and i'd like to see, probably mr. boone or mr. miller our mr. andrews, why it is so important to have the three legs of the competence of aspect of this bill. >> you know, i will try to be pretty because i know time is running out. you talked about the system and how the system be changed and how you set to so many of our subcommittee hearings. and i know that so much of the emphasis today is on the money. and i don't want to take away from the debt and the money and all that. but i think that what we're talking about here in so much of our hearings and energy and commerce was devoted to this, is that changing the way we do things. and, you know, i'm not trying to be critical, mr. hensarling, but

just to talk about the people that are outside the system. were not covered. the fact of the matter is there in the system. they're going to the emergency room. you know, they aren't getting care but they're getting the wrong kind of care at the wrong target everyone is in the system. everybody gets health care. nobody can be denied care if they go to in an emergency room or a clinic or whatever. but we're trying to change the way we do things. and there hasn't been that much attention to the fact that the whole way we deliver health care is going to be changed. not in the money or insurance so much, but the fact that it will be prevented. people will go to see a doctor on a regular basis but they book is the primary care, and different innovative ways of trying to look at care so that it's not just one doctor here and one doctor there, but the whole system, the concept of the medical home. they're so be things like this that change the way we deliver health care that will not only save a lot of money, as i've said many times today, but also make for better quality care.

and that's what i think when you say change the system, i think that's what president obama was talking about. not so much the dollars, but the fact that we need to do things differently. and visitors of the system very much a way from this. and looking at when you get sick, when you go to the emergency and back towards trying to prevent bad things are happening. spend that's what we have as a prevention in here, too. >> when people see this they will love it because it's such a change in a way we do things. >> we've heard almost universally across the house that people say they want to avoid discrimination based on preexisting conditions. it's hard to find members as he or she is not for that. in order to accomplish that and not spike premiums for insured people come you have to have a larger pool of people that are covered, eventually. you can transition into that, but eventually that's what you have to do. so then people say, why do you

have the exchanges? well, because when you're bringing in the larger pool of people and make the presenting condition work, you want of a competitive workplace unlike these is the marketplace is in this country, that gets the best deal for people. and then people say, well, why do you have to have the subsidies? to get people into this marketplace, if somebody is making 25, 35, $40,000 a year, you can have all the marketplace as you want but they can buy in without the subsidies. and people say what you have to have the spending restraint and the revenue? you can't have the subsidies without the revenue. so i would say to you, gentle lady, that is easy answer which is so glibly stated by people, let's just take care of the presenting condition problem. it doesn't fit together if you don't take the next step and the next step in the next that and make it work to the people in the country deserve more than a half-baked solution that won't work. and that's what this bill does

that spent would the gentlewoman feel? >> i thank my friend for giving. i appreciate this exchange but i just want to share with our colleagues and see if there is any response to a story that has just come out from the "washington post" and the last few minutes. is as house democratic leaders say -- lets you pick houston but leaders say they will take a separate vote on the senate health care bill rejecting an area much criticized the strategy that would have permitted them to gain the measure passed without an explicit vote. and i just wondered if this is a decision that has been made by the house democratic leadership? >> as you know, we're having to sing and we have not put able to get the. that's the whole point of this. at the end of this hearing we will meet and try to speed as it like it has happened. >> reclining my time here. spent with a gentle you yield?

>> yes. >> i believe that there's been significant discussion that i want to thank the house leadership for impact indicating a number of us that that is a fact of what would happen, and i think that we that sanity prevails here and i'm very pleased about that. not as i said before, it's not that it was unconstitutional or illegal. but it was something that we should just done in the light of day straight up. and i want to -- >> it has never been done before on issue of this magnitude. >> we claiming my time here. mr. miller, did you want to say something? >> just to build on what congressman andrews said. we have been incrementally tinkering with this system for 50 years at a minimum. and so when you want to make the kind of change that brings about the efficiencies in the system, the expansion of the system, and controls and you say she in terms of getting value as opposed activity, if you don't, as mr. andrew said, put everybody in it doesn't work. that's an insurance companies.

that's from the medical action is, the providers who say to you over and over again, not as, not as a agree with this bill, this is what you have to do. you are moving to write pieces around. whether you're talking to the providers or the injured industry. they will argue over bits and pieces of this. what we have is to date is a history where all of the actors indicators are just tumbling downhill. businesses, large and small are shedding the coverage. small businesses are shedding the coverage. one of the premier insurance providers, employers in our state government is now putting this surcharge on spouses. a surcharge on children. they are offloading and they have been offloaded for a decade. the cost to the enterprise onto the employees. that is going on all the time. if you're in an organized union, what you see is more and more is going to health care and less and less is going to discretion

and, in people's pockets. so the trends are all in the wrong direction, and they are accelerating. they are absolutely accelerating in terms of dramatically increasing the uninsured in our state today, the l.a. times tells us it's one in four. they tell us there's a 1000-dollar cost bring on that on every californian. so you got to bring the people into the system. you've got to try the efficiencies that you got to drive the savings that you've got to drive the value of the engagements to take place. and the fact of the matter is, with medical i.t., with these changes, you get change in behavior. the kaiser hospitals, one of the most successful enterprises, now patients are able without getting a doctor office visit, and ask their doctors questions and get immediate replies within a few minutes but of what's bothering them. they can check their blood pressure, cholesterol at home and he could be moderate back and forth. studies can go on because of the data systems about what works for people under 45, over 45,

with different prescriptions at how generics match up. and all that is taking place. and there are employers in our state as a if kaiser was not available they could not provide health insurance because of the dramatic difference in those premiums. that's what you are trying to inherit on behalf of businesses, families, and on behalf of our economy. are those changes in this system. because what is the business roundtable, the chamber of commerce, small business grants, family groups, all the rest of this, all of these indicators are getting worse with the status quo. and with the constant incremental fooling around with a system. and that's what we are today. you don't get to do this without being comprehensive. if you want, the savings and the efficiencies and the expansion of service to people of quality care of. >> thank you. 30 seconds. >> as a member of the energy commerce committee, i think what's been left unsaid is that the health care systems that we operate right now on medicaid a 60 cents on the dollar.

medicare pays 70 cents on the dollar. your discounted the impact of this cost escalation, and where developing a new government system that's going to underpay. and that's our concern about instead of a private market solutions the. >> for primary care, the reimbursement from medicare and medicaid level pics of anything we're doing speedy's i'm using a centralized system. >> retaining my time. i thank what we're saying here is in order to have this kind of reform, to better care the ring the cost, covering more people, making it more affordable, is that you have to have a companies of system because it's all in balance. so with that i yield back my time. >> doctor fox? [inaudible] >> buckle your seatbelts, everybody.

[laughter] >> bumpy ride. >> doctor fox, your time. >> thank you, mr. chairman. i like what mr. sessions said earlier in this characterization, of what we're dealing with here. we are dealing with a bill that your site is very bad. that's the senate bill. but you like the reconciliationr -- once the senate bill passes, it becomes law. your passing a bad bill. a bill that most of you say that you do not like and a bill that the chairman of this committee said that she did not like. he will vote on that and pass that bill in the hopes that you'll be able to pass what is in the reconciliation bill to

fix the bad things. i think it is real important that we go over the occasionally in this debate. over that occasionally in this debate, or in this discussion, to clarify that. the other thing that i -- >> would the gentleman yield on that? >> no. spirit but at some point i would like to respond. >> i would like to set the stage a. the other thing is that we been told over and over and over again that everything is going to be out there for 72 hours, and that we would have time to consider it. and we know that some of you have seen the manager's amendment, but we have not. it just came. but we're not going to have 72 hours to be able to consider the manager's amendment before we vote on the rule, and on this. so i just want to point out that the things i've been told to us

are not accurate in terms of what the rules are going to be. my -- and i want to say, to put it in plain terms, the things that mr. ryan was saying a little earlier about spending money to times are saving and spending it, you do, the folks in my district with a you're talking out of both sides of your mouth. and i think most people in this country understand that kind of language. i have several questions i want to ask. i'm going to start, if i can, with mr. camp. and say, again, would you talk a little bit about the expanded role of the irs in this legislation? >> well, in the senate bill, there is an unprecedented expansion of the irises authority, and i would say to my friends on the other side, they have given a very articulate

description of central planning and health care. and the central planning will be enforced by the iran us. the irs, under the bill, and i could, would regulate the economic and financial decisions about how and when health care is paid for and what health insurance is purchased. there will be individual mandate -- skidding, and individual mandate tax which will be phased in over a period years which will go into effect fully into effect in 2016 which will be the greater of $750 per person, up to $2250 per household. or 2 percent of household income, whichever is greater. and again -- >> go back and read the definition again and the role of the irs. i just want everybody to hear that. >> the irs will regulate the economic and financial decisions about how and when health care is paid for and what health care is purchased at the iris will be was vital for

enforcing this individual mandate tax. that means the irs would audit and assess interest and penalties on taxes to the irs, the irs determines, did not purchase government approved health care insurance, or pay the individual mandate tax. and according to the congressional budget office on november 20, analysis and the joint committee on taxation, nearly half, 46 percent of the individual mandate tax collected by the irs would be paid by households earning less than 300 percent of the federal poverty line. that is $66,150 for a family of four. >> and what was the presence promise about people not paying extra taxes? >> it was not to pay taxes on families earning less than $250,000 per year. now to assist the irs and enforcing the individual mandate tax, the bill would require that everyone provide, but everyone who has health insurance would

send an informational return like a 1099 to the irs and also then, if it is unemployed they would send it to the individual and the irs as well. so that the irs will be charged with tracking the monthly health insurance status of roughly 300 million americans because even if you are out of compliance, for one month, if you don't have health insurance for one month, under the legislation you would they want wealth of the annual penalties i want to early. now, the congressional budget office has assumed in their analysis that the irs budget would have to grow by $10 billion. this is not my number. this is cbo's number of. >> and thus i put in the cost of this bill? >> that's not include any analysis. so while we had a big discussion on the cbo analysis, i agree with the analysis, as far as it goes. and the analysis does not

include the $10 billion that cbo says in or to fulfill all these new duties and obligations in the legislation, that they would be. and if you look at an estimate -- let me just say we did have testimony before the ways and means committee just this week, from the national taxpayer advocate, and the national taxpayer advocate is very concerned that the iris will be able to offset people's refunds. so here you've been struggling to make ends meet. you finally get to april 15. you think you're going to be receiving a cash refund to help you and your family, and the irs can offset that if you come at any period of that year, on without health insurance for any portion of any time. >> and hasn't been any analysis of how much this is going to cost employers in this country to send the statements out to the employees of? >> no, i've not seen an analysis with the private sector obligations will be.

the congressional budget office only tracks what the government expense or the impact on the federal government will be. there's no comparative analysis on the private sector, or on jobs. the legislation and though would exempt two groups of people from the individual mandate tax. one is incarcerate individuals because obviously they get health care by the fact that they are in prison. and secondly, illegal aliens. those two groups of people are exempt. and if you -- i guess i would just include -- >> can you follow up on that a minute. if illegal aliens are exempted from this, then that assumes something different from what i believe mr. andrews said earlier was that illegal aliens would not be allowed to be covered under this bill, and answering mr. sessions questions. >> no, i will say this. they don't allow them into the

exchange so they can't, there's an issue there whether they do or not. but the concern is, if an average american doesn't have health insurance, and the reason that they have to pay this individual mandate tax is the cost of them going to the emergency room without health insurance, then why does that not apply to illegal aliens who will also be unveiling themselves of emergency room services when they need help wax so i guess i would say that, you know, to summarize, illegal aliens will be able to continue to go to the emergency room, not have to be responsible for this individual mandate tax. well, the uninsured american must pay that tax. and i would just go by sink there's an unprecedented level of involvement by the irs, a dramatic increase in the role and function, under this

legislation that led tens of billions of dollars to the cost of implementing this. it's not good in the cbo report. >> let me see if i can summarize what you said about illegal aliens. illegal aliens will not have to pay a tax for not having insurance. they can continue to go to the emergency room, or get their care and free clinics or whatever. they don't have to pay a tax, bright? >> right. that's correct. >> but we will still be paying for the health care. >> do illegal aliens pay taxes or -- is that something we're collecting right now the? >> some do, obviously they do. they are working and they're paying taxes. they do that all the time emac they're obligated to pay taxes, where they did do out. >> some do and some don't.

so they are paying taxes. some are paying taxes, some are not think taxes. >> a gentle lady you for another question? is what we're saying here is they are not allowed to buy insurance through the exchange. exchange. so i don't see how you could penalize him for not buying it through the market place. so are you suggesting we should allow our undocumented population to purchase insurance through the market place of? >> i'm not suggesting anything. i'm just trying to clarify what you all are allowing and not allowing spent under the house bill, we did allow our undocumented population to buy insurance through we caught the exchange is on or the marketplace mechanism. there were several of minutes that were offered by members of your party, i recall at the time, for this committee, that would've ended the ability of our undocumented population to buy insurance through the exchange. i asked one of them, i recall, how we intended to pay for the. and we don't allow them to buy insurance, we are then forcing

others to pay for their uncompensated care. unfortunately, the senate bill does not have this provision. so the gentle lady is correct that by not allowing undocumented immigrants to buy insurance through a market place where forcing taxpayers to cover the subset of them that otherwise wouldn't insurance. i yield back. >> dr. park, if you would you do one quick observation the mac we also want to remember that because the undocumented were left out of the exchange and therefore cannot dissipate in health program, their own access would be to the emergency room. they can't use the emergency room the way you use your doctor visit or regular hospital visit. when you go to an emergency room you get care based on the urgency of your condition. and so for folks are coming to the emergency room, it's because they have an emergency condition. if they don't, they go to the very back of the line and may or may not get treatment. the emergency room is less for those who have an emergency condition. contagious disease.

i don't believe that we would want to say that we want to exclude anyone who happens to be in this country if they have a contagious disease, the bird flu our swine flu or whatever, you would not want to exclude people if they truly have an emergency condition. that's a really the undocumented population with. >> we have to go vote. [inaudible] [inaudible conversations] [inaudible conversations] this is live coverage on c-span2. >> this committee will please come to order. i will call up an amendment by the energy commerce committee. no, i won't.

what's that? the chair will receive a motion from mr. mcgovernor. >> madame chair, i move -- >> going the club. >> i move the committee report a single rule to the senate 3590 the patient protection and affordable care act and the hr4872 the reconciliation act of 2010. the rule provide for two hours of the debate of topic of senate amendment and hr4872 equally divided and controlled by the majority leader, minority leader, ordines knees. upon completion with respect to the hr3590, the rule makes an order the motion offered by the majority leader that the house concur in the amendment. the motion shall be in order without intervention of any point of order accept those arising of rule 21.

the senate amendment and motion should be considered as read. if the motion is concurred, the resolution provides for a consideration of the hr4872 under a closed rule. the rule waves all points of order against consideration accept those arising under clause 10 of rule city. it provides that the -- rule 21. it prod sides in the amendment printed in the part 8 accompanying the resolution modified by the amendment should be called as adopted and the bill has amended should be considered as read. the rule waives all points of order as amended. the rule provides one motion to recommit with or without instructions. until completion of proceedings enabled by the first session of the resolution, a, the chair may decline to entertain any intervening motion accept as provided herein. resolution question or notice b the chair made the client to the

question of consideration, c), the chair may postpone such proceedings as designated by the speaker. b), clause 1a of rule -- >> 19. >> 19 shall not apply. any proposition add miserable under the first three sections of the resolution should be considered as read. finally the rule directs the clerk in the engrossment to amendment the title to read. quote@@@@#

something like that. >> i want to say 12. >> we've been here for a very, very long time. and, you know, it was interesting that earlier today i reminded our colleagues of the document a new direction for america. and i read the paragraph in here by then majority leader for an open process when it comes to debate and all. then i read the paragraph that said that was nancy pelosi's commitment that she made as she was campaigning for the majority. one the promises was members should have at least 24 hours to exam bills and conference reports, the text prior to floor consideration, rules governing floor debate must be reported before 10 p.m. for a bill to be considered the following day.

now let me -- so obviously we've blown that one out the window tonight. let me just say -- shall i read it again. it say reported before 10 p.m. reported before 10 p.m. i don't think that's going to happen. let me say that it is somewhere unorthodox as i look at the resolution itself that's before us. we're not debating any legislation, we're debating topics. >> uh-huh. >> upon adoption of the resolution to be in order to debate the topics address bid senate amendments. and then we will have consideration of the measures. and i wondered if you could explain to us, madame chair, why it is that we're debating topics here as opposed to the legislation that is going to be placed before us? >> actually, the two hours of debate is on the legislation. i think -- >> no it says debate on the topics addressed. >> i don't know why the words topics is used, we'll obviously be talking about legislation. >> okay.

well, it is someone unorthodox to be doing that. >> well, all right. >> i'll just let that stand. and say you know this call that ms. pelosi made when she was seeking an opportunity to merge in the majority, what that we would have an open debate. i'm going to give every member of the opportunity to allow for the kind of free flow and open debate that ms. pelosi promised us she would have when she authored a new direction for america. i move we allow to be open process. >> thank you, you've heard the gentleman's motion. any discussion? [inaudible] >> what's wrong? >> thank you.

there was the ability to go to conference. i might treat this as a conference report. i wanted to say that directly and i feel the way we are handling this is absolutely appropriate tonight. there's a lot of the proposed amendments that are going to be offered that i can support and i do support. i'm not going to support the chair because it's carefully crafted amendment between the house and senate. unfortunately, we couldn't do this in the traditional processes. but i think that we will move forward in the future, find to do some the thing that is are subjected here today. which we could have done in conference had the senate agreed to go. >> all right. any other discussion? >> madame chair. >> yes. >> can i ask a question? did the senate even attempt to go to conference? >>y, they did. >> they did? >> yes, they did. >> thank you. >> and as we all know, the congress reports are not

amended. >> let me follow up, how could they have attempted to go to conferences. they didn't pass the same bill? >> they didn't? >> well, they didn't. >> you often go to conference on different bills. senate and house bills go to conference. >> right. >> so they can be reconciled into the single bill. >> let me just say, madame chair, an attempt can be made to describe this as a conference report. because under the constitution, the senate did in fact exercise it's rights to take the actions that they did. that to me is -- if this were a standard conference report we wouldn't be offering the amendments that we're going to offer this evening. so i think that the recognition that this is not a conference report, it could be treated like a conference report if someone chooses to do that. but it's not a conference report. for that reason, i believe we should've should have an open rule for the consideration of the amendments. and madame chair, i will say that as i have told you

privately we are going to be having votes on the amendments this evening. we will have no more, no more votes at all this evening if we simply adopt my amendment for an open rule. that assures you that everyone can go home and we won't have to have this protracted debate. no more recorded votes. in fact, we don't need a recorded vote on this. we can buy a voice vote and move to have an open amendment process and then we can all say good luck and good night. >> does everybody feel like they need to put their hand in the pocket and feel like they wallet is there? [laughter] >> my hands are up. [laughter] >> the american people are all doing that as they look at the legislation. because $1 trillion is a hell of a lot of money. [laughter] >> mr. mcgovern. >> let's be clear. if we were to adopt the amendments it would be the senate is able to filibuster this measure.

they wouldn't even have a vote on health care. we've been talking about health care reform, i think the majority of americans want america. we have been denied the right to vote because of the republican leadership in the senate. the republican leadership is used every single elementary move and manipulation. you know, i'm happy to be here all night. i'm happy to be here all night and vote on your amendments, mr. pryor. yes, i yield. >> let me just say that every single amendment that we are going to be offering this evening is to the reconciliation bill. >> well. >> and so it is not in any way due. what i said -- >> i will resay -- >> i will reclaim my time. i will restrait this is an attempt to try to derecall the legislation. this should be treated as the congress report. because the republicans choice not to participate, there is a clairefully negotiated agreement between the house and senate. we need to move on this.

we could have a vote and finally be able to give the american people health insurance reform which they've been longing for decades. >> madame chair, let me say we all share the goal. we can have the kind of debate and get exactly where i believe both political parties want to be. that is meaningful -- meaningful reform to ensure that americans will have access to affordable health insurance. i believe that having an open rule will, in fact, give us that chance. so i encourage my -- >> i don't think both parties agree on that. >> hardly. let's begin the voting. i will call the vote. all in favor say aye. opposed no. >> madame chairman we have a recorded vote. >> no. >> no. >> no. >> no. >> no. >> no. >> no. >> aye. >> aye. >> aye. >> no.

>> reports total, motion is not agreed to. any further motions, mr. pryor. >> yes, i move to amend the rule to provide for any record vote demanded on passage of hr4872, the speaker shall use her authority pursuant to the clause three of rule 26 to direct the clerk to conduct such a vote by a call of the roll. now this is something that is done at the beginning of every congress. we've all gone through this when we had the election of the speaker of the house of representatives. and everyone is recognizing what an -- a monumental vote this is. how extraordinarily important it is. so this amendment would simply state that when we go to a recorded vote on passage of this legislation we would have the clerical the roll of the members. and i believe that it's a common sense way for us to deal with

the issue of accountability and transparency which everyone likes to talk about around here. >> i heard the gentleman's motion. any discussion? >> madame chair, there's a question. >> mr. mcgovern, you may. >> when i vote, i put my card in the machine, then it lights up yes or no. the issue of transparency. okay. thank you very much. >> any other discussion? >> yes, madame chair. let me say that the right to -- or the opportunity to simply put a card in and -- >> it's not american. >> is unmore than? >> is that what you're getting at? >> um. let me see. it's the idea of putting a card -- no i have to think about your question. you've now asked me if i believe it's un-american -- you've asked me if i believe it's un-american -- >> i think it's the tread of the

conversation. >> you asked me -- >> you think only roll call vote is valid. >> no, i don't. what i believe -- no, i don't want both. let me reoffer the amendment. what i have said madame chair is if we are to make this amendment in order it would simply say that when we get to the vote on passage that each members of the house of representatives when they name it called by the clerk simply stand as we do at the opening of each congress. when we have the vote for speaker and state whether they are voting yes or no when the clerk would call the roll. >> you've heard the gentleman's motion. is there any discussion? >> all right. thank you. the vote that we yield when we put or card in the slot is recorded vote for all times. i think that's going to be sufficient. i'm going to vote no against this amendment. >> any other discussion? if not the vote -- all in favor

say aye. >> aye. >> opposed no. >> no. >> record vote please, madame chair. >> no. >> no. >> no. >> no. >> no. >> no. >> no. >> aye. >> aye. >> aye. >> no. >> motion is not agreed to. are there further motions? >> yes, mr. pryor. >> i move the committee make an order and provide the appropriate favors for amendment 53 which would prevent this bill from taking effect until the office of management and budget certified that the federal budget deficit has been eliminated. >> you've heard the gentleman's motion is there any discussion? if not the vote occurred on the motion. all in favorite say aye. opposed no. >> could we have a record vote, madame chair? >> no. >> no. >> no. >> no.

>> no. >> no. >> no. >> aye. >> aye. >> aye. >> no. >> motion is not agreed to. further motions? >> yes, madame chair. i move that we make an order and provide the appropriate waivers by amendment 55 which has been offered by a colleague from illinois which would require a certification that the bill would lower national health cost. :

[roll call] ha >> the motion is not agreed to. further motions? >> i'm of the dominican order to provide amendment 48 offered by, mr. barton of texas and mr. john

sam johnson of texas which would remove the provision which provides the extra funds for louisiana medicaid program which has been known as the louisiana purchase, and we will have an opportunity to strike that if we make this amendment and donner and i encourage is a colleagues to support it. >> any discussion? if not the vote occurs on the motion by mr. brown. all in favor say aye. opposed, no.

gentleman's motion and is there any discussion? if not the vote will occur on the motion. all in favor, say aye. pos, no. >> a recorded vote, madame chair. [roll call] the clerk will report the total. the motion is not agreed to. mr. dryer. >> provide the appropriate waivers for amendment number 50 offered by barton and johnson which would remove the provision that would allow certain hospitals to benefit from section 508 if it means high your medicare payments. >> you heard the motion. is there any discussion? if not the vote occurs on the

motion. all in favor, say aye opposed, no. recorded vote, please. [roll call] the clerk will report the total. the motion is not agreed to. further motions. some thank you. provide the appropriate measures for amendment number 54 offered by mrs. burton and john said which would remove the provision that provides for increased medicare payments to hospitals and doctors in the frontier states. >> you have heard the gentleman's motion. any discussion? if not the focus on the ocean by mr. dreier. all in favor, say aye. pos come no. in the opinion of the chair, the noes have it. >> recorded vote. [roll call]

the clerk will report the total. the motion is not agreed to. >> of the committee make movement to provide amendment number 70 offered by burton and john said which would repeal the provision offered in medicare coverage to certain individuals exposed to environmental health hazards. >> you've heard the gentleman is motion. is there any discussion? if not, the vote will occur on the motion by mr. dreier. all in favor, say aye. opposed, no degette in the opinion of the chair the noes have it. recorded vote, please. [roll call] the clerk will report the totals. the motion is not agreed to. >> i'm of the committee in order

to provide the appropriate waivers for amendment number 76 offered by mrs. burton and johnson which would repeal section 6000 in of the bill to limitation on medicare exception to the prohibition on certain physician referrals for hospitals. >> you heard the motion. is there any discussion of exit of the vote will occur on the motion. all in favor, say aye. opposed, no. in the opinion of the chair of the noes have it. roll call vote, please. [roll call] the clerk will report the tools. >> thank you benign of the committee may order to provide the appropriate waivers for amendment are 65 offered by mr. sculley is which would strike the individual health care mandate. >> you heard the motion. any discussion of exit of the vote will occur on the motion all in favor, say aye.

a post, no. in the opinion of the chair the noes have it. recorded vote, please. [roll call] the clerk will report the totals. the motion is not agreed to. >> adam geren of the committee in order to provide the appropriate waivers for amendment number 84 offered by mr. shadegg, ms. blackburn and mr. brown of georgia which would add a section on interstate purchasing of health insurance, something that both parties say that they support, the president has indicated his support of this notion and i believe that making this amendment in order would go along way towards ensuring that we reduce the cost of health insurance for the fellow americans. >> you heard the gentleman's motion. is there any discussion? if not the vote will occur on the motion by mr. dreier.

all in favor, say aye. [roll call] the clerk will report the totals. the motion is not agreed to. >> the committee in order to provie the appropriate waivers for amendment number 88 offered by mr. brown of georgia which would allow for 100% deductibility of individual medical expenses. >> you heard the motion to read any discussion? if not the focus on the motion. say aye. the post, no. record vote, please. [roll call]

the clerk will report the tools. i want to say, madam chair, that i was considering, since we do have all of these amendments on the floor as once again offering and i will make the request for an open amendment process so that we don't have to go through this, but it sounds like we are going to. i know mr. diaz-balart has some. >> thank you, madame gereed i have the amendment to the rule i ask a brief waivers for amendment number 82 offered by representative brown weight of florida, which will eliminate any cuts to medicare in the bill. >> any discussion? if not the vote occurs on mr. diaz colored. all in favor, say aye. opposed, no. in the opinion of the share, noes have it. recorded vote, please. [roll call]

the clerk will report the totals. the motion is not agreed to. mr. diaz colored. >> i'm of the committee meet in order and provide the appropriate waivers for amendment number 91 offered by representative cassidy of louisiana of which would clarify high deductible health plans with an hsa meet the definition of adequate coverage, furthermore any new standards adopted by the secretary shall not apply to a high deductible health plans and health savings accounts with such standards would have the effect of disqualifying such plans from meeting the central requirements. >> thank you mr. diaz colored. any discussion? of of the vote will occur on the motion by the gentleman from florida. all in favor, say aye. opposed, no. in the opinion of the chair, noes have it. recorded vote, please. [roll call]

the clerk will report to totals. the motion is not agreed to. >> i moved an amendment to the rule the committee an order to provie the appropriate waivers for amendment number three offered by representative cold oklahoma which would require that savings resulting from spending reductions in medicare stay in medicare to pay down long-term unfunded financial obligations. >> you heard the gentleman's motion to be any discussion? if not the vote will occur on the motion by mr. diaz followed. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. recorded vote, please. >> recorded vote. [roll call]

>> the clerk will report the totals. the motion is not agreed to this church does dollar. >> i have amendment to the ruling of the committee in order and provide the appropriate waivers for amendment number 32 offered by representative rogers of michigan which would express the sense of congress that any of social security payroll tax revenue that results from this legislation and will be used for future social security benefit payments scheme to for the gentleman's motion. is there any discussion? of what the vote will occur on the motion all in favor, say aye. opposed, no. the opinion of the chair, the noes have it. >> recorded vote, please. >> recorded vote. [roll call] the motion is not agreed to. mr. diaz built. i have amendment to the role the

committee for the diprete wafers for amendment mur 43 offered by representative francs of arizona which would prohibit the cuts to medicare advantage plans. >> you heard the gentleman is motion. is there any discussion? if not the vote will occur on the motion. all in favor will say aye. opposed, no. in the opinion of the chair the noes have it. >> recorded vote, please. >> recorded vote. [roll call] the clerk will report the totals. the motion is not agreed to. mr. diaz-balart. i have an amendment to the rule the committee an order to provie the appropriate waivers for amendment number 73 offered by representative rogers of michigan which would require their to be no changes to medicare advantage for a given year until the hhs secretary certifies that no senior will be forced away from or lose their

enrollment in the plan like to get in touch point they would enroll on as of the day before enactment of the bill. >> you heard the gentleman's motion. is there any discussion, any questions? if not the vote will occur on the motion. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> recorded vote, please. [roll call] the clerk will report the total. the motion is not agreed to. >> i have an amendment to the rule the committee an order to provie the appropriate waivers for amendment number 45 offered by representatives of california, of louisianan and brown of georgia which would prohibit cms from making coverage determination's using a comparative effectiveness research solely on the basis of

cost. >> keefer if the gentleman's motion. is there any discussion? if not the vote will occur on the motion. all in favor will say aye. opposed, no. in the opinion of the chair, the noes have it. >> recorded vote, please. >> recorded vote. [roll call] >> the clerk will report the totals to read the motion is not agree to treat mr. diaz-balart. i have an amendment to the rule. i move the committee an order to provie the appropriate waivers for amendment number i can offer by mr. burgess of texas which would require that to have a call for a state plan under the medicaid program states must provide at least 75% of the payment rate paid to a provider under the state employees pan or the federal employees health

benefit plan. most chosen by families. for dental and vision services in the case where such services are covered under a state employee plan providers must be paid at least 75% of the rate paid under the plan. in the case for supplemental dental and vision services are not offered to a state employee providers to a state employee providers must be paid at a rate of 75% of the rate paid by the supplemental vision and dental, federal employees health benefit plan most chosen, most often chosen by families. >> you heard the gentleman's motion. any discussion? if not the vote occurs on the motion. all in favor will say aye. opposed, no. in the opinion of the chair, the noes have it. >> recorded vote, please. >> recorded vote. [roll call]

the clerk will report the totals >> say aye i have an amendment to the rule the committee meet appropriate waivers for amendment number 20 offered by representative purchase of texas which would establish a utilization review and appeals process for qualified health plans. semidey for the gentleman's motion. is there any discussion? if not the vote will occur on ne h ,@@@@ @ @ @ @ @ @ @ @ @ @

hospitals. it's been a key for the gentleman's motion. is there any discussion? >> if not the vote will occur on the motion by mr. diaz colored. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> recorded vote, please. >> recorded vote. [roll call] the clerk will report the totals. the motion is not agreed to. mr. diaz-balart. >> i have an amendment to the rule and i move that the committee make an order to provie the appropriate waivers for amendment number 52 offered by representative terrie of nebraska which would strike markets basket update reductions >> you heard the gentle man's notion. any discussion? if not the vote will occur on the motion. all in favor, say aye.

opposed, no. in the opinion of the chair, the noes have it. >> recorded vote, please. >> recorded vote. [roll call] the clerk will report the totals. the motion is not agreed to. mr. diaz balad. >> i have an amendment to the rule and i move that the committee make an order to provie the appropriate waivers for amendment number 78 offered by representative upton of michigan which would prohibit the bill from taking effect until the medicate trustees published projections that show that medicare with solvents for the next 30 years. >> you heard the gentleman's motion. is there any discussion? if not it will promotion. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> recorded vote, please. >> recorded vote. [roll call]

the clerk will report to totals. the motion is not agreed to. mr. diaz-balart. >> i have an amendment to the motion i move that the committee make an order to provie the appropriate waivers for amendment number 56 offered by representative whitfield of kentucky which would remove the prompt the discount from the medicare part b reimbursement formula. >> you heard the gentleman's motion. is there any discussion? if not the vote will occur on the motion all in favor, say aye. opposed, no. the noes havein the opinion of e noes have it. >> recorded vote, please. >> recorded vote. [roll call] the court will report to totals. the motion is not agreed to.

mr. diaz colored. >> thank you. i have an amendment to the rule and i move that the committee make an order to provie the appropriate waivers for amendment number 57 offered by representative what field of kentucky which would place a moratorium on the cuts to the reimbursement for procedure performed by interventional paying physicians. >> you heard the motion. any discussion? you did not hear the motion? [inaudible conversations] >> representative whitfield of kentucky. [inaudible conversations] >> i don't believe you testified. >> we could probably call him up here if you like. [inaudible conversations] >> any other discussion? if not, the vote will occur. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> recorded vote, please. >> recorded vote, please. [roll call]

>> the clerk will report the totals. the motion is not agreed to. mr. diaz ballard. >> thank you. i have an amendment to the rule and i move that the committee make an order to provie the appropriate waivers for amendment number 41 offered by representatives loomis of wyoming and sam johnson of texas, which would allow states to opt out of any provisions of the bill to the extent that they mandate to the purchasing of health insurance by residents of such a state mandate provision of health insurance by and lawyers in such state or interfere with the ability of patients to privately contract with medical providers and insurers under the laws of such states. >> you heard the gentleman's motion. any discussion? mr. mcgovern. >> did they testify? >> i think they did. >> i don't think they did. >> no, they did, i was just curious the strong -- how strongly they felt. >> any other discussion? [inaudible conversations] >> if not, the vote will occur

on the motion by mr. diaz-balart. say aye. opposed, no. in the opinion of the chair, the noes have it. recorded vote, please. [roll call] the clerk will report the totals. the motion is not agreed to. mr. bdy as ballard. >> thank you. i have an amendment to the rule and i move that the committee make an order to provie the appropriate waivers for amendment 95 offered by mr. darrell issa of california, which would strike all after the enacting clause and insert the language that would allow every american to obtain the same health insurance that members of congress have by using the existing framework of the federal employees health benefits plan. the office of personnel management would contract with insurance providers to make

private health insurance plans available to all americans. >> you heard of a gentleman's motion. any discussion? >> did he testify? >> i don't know, but i remember you making an order -- >> no, i'm just curious. >> [inaudible] i don't know if he came up or not but there's plenty of precedent if they did not come and i hope that you make -- >> i'm just curious how strongly they felt about it, that's all. >> of this amendment -- this amendment -- spent a lot of the people testify -- >> madame chair -- excuse me, gentlemen, the reporter cannot possibly -- >> do not have the time? >> i'm just sitting talking over each other she can't hear what you're doing. >> [inaudible conversations] >> i don't know because i wasn't

here throughout the entire fifth president. >> i reclaim my time. i reclaim my time. it is my time. i was here the entire ten hours. he did not testify. i was just curious how strongly he felt about it. >> there's plenty of precedent. >> just a question. >> are we still at the stages of discussion. madame chair, if i may ask, and i would ask unanimous consent to include the statement of administration policy. i don't believe that we had put that in the record. >> without objection, so ordered. >> -- earlier today. and also, unanimous consent to include the number 25 sold in statement. now madame chair -- >> without objection. >> i was keeping a log and to undergird but mr. governor was speaking about, so as how the

american public will understand a little bit about our process. when a call is made for a rule, an agenda is established. in this agenda, which has an eight close to 48 of our distinguished colleagues who are listed and a significant number of them did come here and testify beginning at 10 a.m. this morning. some of the amendments as offered, and let me make it very clear my colleague from florida is correct there is abundant president for offering an amendment when a person has met the call and submitted the amendment but i find that passing strange that a significant number of amendments are being offered, which to my way of thinking could only be for dilatory purpose is.

useless dilatory purpose is as we proceed and people like ginny brown-waite, mr. kohl, mr. rogers, mr. would feel, mr. issa deployed come here and testify as mr. mcgovern says. it kind of signals that they don't care about it but just carry it one step further and i ask my distinguished colleague and friend from florida does this measure as offered by mr. fisa in pact the deficit at all? >> i am not aware of that bible say that if the gentleman would yield. i will say that with regard to our distinguished colleagues not having been present today to testify, perhaps they believed the speaker when she said amendment would not be made in order. so, you know, but with regard to that -- >> reclaim my time to get just reclaiming my time. my friend, of course,

understands that this matter is being treated as a conference report, and conference reports are never amended in this process. all of you are very much you that but to demonstrate what mr. mcgovern and i were talking about, the simple fact that you don't know what mr. issa's amendment does with the deficit suggests to me that you don't even know what the amendment is about that you are offering, and if you don't know, i don't know why you expect that i would no. >> if the gentleman will yield. if my friend would yield. if my friend would yield. what i am asking for -- and especially since this is not a conference report, is that the ability that the house have the ability to debate this. obviously, i am not going to know the intricacies of the amendment, but my friend knows that if the house is allowed to

consider this, the details and the debate will come out and through the discussion on the floor obviously questions will be made and questions will be answered. >> reclaiming my time, you see mr. issa had an opportunity to come up here and submit to this particular body so that we might as we did with authors have a free ranging dollar. i've never seen anything like it we had an economic seminar today for all intensive purposes. he chose not to come. you are offering something that you don't know what he would have said and you are telling me about precedent and i am telling you that you don't know what you are offering and i don't know why you expect me to know. i yield back the balance of my time. >> mr. dreier. >> thank you, mr. chair. but me say since the last statement made by my friend, mr. hastings, plus and president. for starters, i was seeking

recognition. the president is that been debating in this committee, a member of the majority is recognized and a member of the minority is recognized. both mr. mcgovern and mr. hastings has preceded to imply and flat out state by mr. hastings that by virtue of not coming before this committee that these members don't care about their amendments. that's the exact term i wrote it down as mr. hastings said. he said they don't care about it by virtue of their not being here. we did have between four and five hours of debate with the chairman and the ranking members of the committees of jurisdiction, and we had much going on today as we all know we spent an hour on the floor with democratic members changing their vote on the rica metal motion that was on the floor and lots of other activities were going on. now, this foxx sat here and was

the last witness, the very last witness before this committee after we went through whatever it was, eight, nine or ten hours. i don't see her amendment having been made an order, so if the fact someone is here testifying and she very thoughtfully outlined her amendment dealing with the student loan issue and get unfortunately it was not made an order, we know -- we know that when you are given -- we had 70 some odd amendments submitted to this committee and with members coming and going, i mean i don't want to mention other names but there are other members who as we know wanted to testify in this committee hearing happened to come before the last member got here to testify >> [inaudible] >> i don't hold the gavel. as the mix what are we supposed to do? wait for them to come? >> what i'm saying is does that mean, is the gentleman saying i would ask, madam chair, that she

doesn't care about offering her amendment. it is just when we in this committee go through the laborious process that we do of trying, struggling to have the kind of free-wheeling debate that was promised to us and we are simply asking amendments be made in order mr. diaz-balart should not be expected to know the details. he's simply saying why don't we find out what the @ @ @ @ @ @ @ "

correction. but i am amused by sitting here at this hour and we did so sorted mr. matsui and ms. mcgovern and by many times and i remember very vividly doing exactly what i just did to lincoln you doing to me sitting where ms. foxx is -- >> can my reclaim my time? skype will the gentleman let me finish? thing you know where i'm going with this. [laughter] >> if i can reclaim my time and then i will look forward to yielding. i will yield to my friend in just a moment. i reclaim my time to save the life of a kind of exhausted this notion of arguing in years past

versus the change that we were promised. we were promised a new direction for america which included the work of the house rules committee, and i have acknowledged and admitted that when i sat in the shareware mrs. slaughter is that i didn't do a perfect job, and i could have done a better job. i will let knowledge that to my friend, but the constant effort to say you did this so we should do this is completely irrelevant because of the promise that was made to the american people and to this institution and i am happy to further yield to my friend. >> the point i wish to make an well for my friend is i sat where ms. fox is and i offered amendments of a member under the same precedent we are following offering amendments with people but chose for whatever reason to not come to the rules committee and testify and submit themselves to questions and

dialogue, and you asked me as i did mr. diaz-balart to explain the amendment and i was not able to do so. that isn't tit-for-tat. i am just saying to you that it happened. and it happened at a later hour i might add, but i will accept the irrelevance. what what else is irrelevant is these people are at the very least have not been here to the committee and i began and i thank the gentleman for yielding and i began by saying i wanted the american public to representative least understand that this stuff isn't just made up, that these people actually filed their amendments and that they did not appear here and now they are being offered sometimes by people who don't know what is in them. >> madame chair, if i could reclaim my time -- if i could reclaim my time, and then i'd be happy to yield to my friend -- are you going to call -- is the gentleman going to call the question so i can see if i'm

going to be cut off in debate here. >> mr. perlmutter we don't do that in the rules committee. mr. dreier has the floor. >> thank you very much madame chair. let me simply say, and i'm responding to mr. hastings and mr. mcgovern, both of whom have raised this serious charge that somehow if members don't come before this committee that they don't care about their amendment, and maybe it is my implication of that mr. hastings has said that he did not mean to directly say that. but the point is we would have complied, we would have complied with the direction for a new america item that said bills shall be reported by 10 a.m. for a meeting open rule in order. now the thing that is disturbing to everyone here is that as we look down to mr. polis isn't here this moment he stepped out, these are members of this committee who have never once

from this committee had an open rule reported out. never before in the history of the public have we gone through a congress where there has been not one single open rule, and every day that goes by, madam chair, i should say that we have set this record, never a session of congress that was last year, and now as we are headed towards the end of march, we are still with this perfect record of no open rules for the entire congress, and i think that in and of itself is a very, very unfortunate thing. steno further discussion the vote will occur on than motion of mr. diaz-balart. all in favor, say aye opposed, no. in the opinion of the chair, the noes have it. recorded vote, please. [roll call] the clerk will report the

totals. the motion is not agreed to. mr. diaz-balart. mr. sessions? >> thank you madam chair. may i have an amendment to the rule and make the committee provide appropriate waivers for amendment 31 offered by the gentleman who was your representative boyer of california that would protect the integrity and independence of the department of defense and the departments of the veterans affairs health care systems and state that the tricare program and the veterans' health care program meet all of the requirements for individual health insurance under the bill. >> thank you mr. sessions. any discussion? if not the voters on the motion by mr. sessions all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. recorded vote, please. [roll call]

mr. sessions. >> me i have an amendment to the rule and move that the committee make an order to provie the appropriate waivers for amendment number 12 offered by the gentleman here in attendance today by blackbird of tennessee that would prohibit exchange plans from being established until the hhs secretary certifies the establishment under the same exchange plan will not cause the cost of the average price of private health insurance premiums to increase. -- before mr. sessions. if not any discussion of what will occur. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. recorded vote, please. [roll call]

baala motion is not agreed to. sprick i have the amendment to the world. i asked that the committee make an order to provie the appropriate waivers for amendment number eight offered by the gentleman representative blackburn of tennessee who was in attendance today which provides that the omb submits a report saying the cost of title one of this bill and the patient protection and affordable care act are 25% or greater than the federal budget than the congress shall consider a joint resolution to repeal such provisions. >> you heard the gentle man's notion. any discussion? if not the vote will occur on the motion. all in favor, say aye. opposed, no. the noes havein the opinion of e noes have it. recorded vote, please. [roll call]

the motion is not agreed to. >> i have amendment to the rule and with that the committee make an order to provie the appropriate waivers for amendment number six offered by jeff flake of arizona that would strike the employer mandate to provide health insurance for its employees. >> you heard the gentleman's motion. any discussion? if not the vote will occur on the motion. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> madame chair, a recorded vote, please. [roll call] the motion is not agreed to. >> i have an amendment to the rule move that the committee make an order to provie the appropriate waivers for amendment by mr. brown of

georgia that requires any business characterized as a minority-owned business or small business concern is exempt from all employer mandates. >> you heard the gentleman's motion. is there any discussion? is not the voters on the motion. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> recorded vote, please, madam chair. >> recorded vote, please. [roll call] the clerk will report the totals. the motion is not agreed to. >> i have an amendment to the rule move that the committee make an order to provie the appropriate waivers for amendment number 86 offered by representative brown of georgia which would exempt any business whose gross revenue per year do not exceed $500,000 from all employer mandates.

>> you heard the gentleman's motion. any questions? if not, the vote will occur on the motion of mr. sessions. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> recorded vote, please, madam chairman. >> recorded vote. [roll call] the clerk will report the totals. the motion is not agreed to. mr. sessions. sprick thank you. i have an amendment to the rule move that the committee make an order to provie the appropriate waivers for amendment number 42 offered by the gentleman mr. paulson of minnesota who was here before the committee today, which would exclude temporary workers from the employer mandate. >> you heard the gentleman's motion. any discussion? if not, the vote occurs on the motion. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> madame chair, i ask for a

recorded vote. >> recorded vote. [roll call] the motion is not agreed to. mr. sessions. >> thank you. i have an amendment to the rule and move that the committee make an order to provie the appropriate waivers for amendment number 97 offered by representative of nevada, which would prevent the $2,000.20 tax from interacting employers in states where on the planet is greater than 6% amendment number 77 offered by the gentleman mr. upton of michigan, which would strike, prohibit the employer mandate from going into effect on employment is over 7%. amendment number 99 offered by the gentleman of georgia, which

would suspend the employer mandate for every year that the national unemployment rate is above 9%. amendment under 64 offered by the gentleman mr. rogers of michigan, which would prohibit the employer mandate from going into effective national on a plan that is over 10%. and amendment number 51 offered by the gentle man michael rogers from going into effect if and a state where unemployment is over 11%. >> you heard the gentleman's notion. is there any discussion? flout, the focus on the motion of mr. sessions. all in favor, say aye. opposed, no. in the opinion of the chair come the noes have it. >> i asked for a recorded vote. >> recorded vote. [roll call]

the clerk will report the totals. the motion is not agreed to. mr. sessions. >> thank you madame chair. i have an amendment to the rule and move that the committee make an order to provide the appropriate waivers for amendment number 58 offered by the gentleman mr. shimkus, who was before the committee today which would allow states to opt out of the medicaid expansion. >> you heard the gentleman's motion. any discussion? if not all of the vote occurs on the motion offered by mr. sessions. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> recorded vote, please, madam chairman. [roll call] the clerk will report the totals. the motion is not agreed to. mr. sessions. >> thank you. i have an amendment to the rule and move that the committee make an order to provide the appropriate waivers for amendment number 57 offered by

the gentleman, mr. shimkus, who was before the committee today, which will provide funds to medicaid recipients so they can buy into impleader sponsored insurance. >> you heard the gentleman is motion. any discussion? if not, the focus on the motion by mr. sessions. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> recorded vote, ple@@>dr@ @ @

by mr. sessions. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> madame chair, may i ask for a recorded vote, please. >> recorded vote. [roll call] the clerk will report the totals. the motion is not agreed to. mr. sessions. >> thank you. i have an amendment to the rule and move that the committee make an order to provide the appropriate waivers for amendment number 89 offered by the gentleman mr. dent of pennsylvania, which would add a new decision title "ending defensive medicine and encouraging innovation." >> you heard the gentleman's motion. any discussion? if not the vote occurs on the

motion. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> madam speaker, recorded vote, please. >> recorded vote. [roll call] the clerk will report the totals. the motion is not agreed to. mr. sessions. >> thank you, adam chairman. madame chair, i have an amendment to the rule and move that the committee make an order to provide the appropriate waivers for amendment number 83, offered by the gentleman, mr. shadegg of arizona and the gentlemen mr. brown speaking on behalf of this amendment which would add a section to the stylish universal access programs to improve high risk pools and insurance markets. >> you heard the gentleman's motion. any discussion? if not the voters on the motion to agree at all in favor, say aye. opposed, no. in the opinion of the chair, the

noes have it. >> i ask for recorded vote, please. >> recorded vote, please. [roll call] the clerk will report the totals. the motion is not agreed to. mr. sessions. stomachs before. madame chair, i have an amendment to the rule and move that the committee make an order to provide the appropriate waivers for amendment number 46 offered by the gentleman who was in attendance today mr. brown which will provide individuals 100% deductibility for all medical expenses reform provide for cooperative governing of individual health insurance coverage and provide for association health plans. >> you heard the motion of the gentleman from texas. mr. mcgovern? >> i don't think mr. brown was here. >> yes, mr. brown was here. >> win? i didn't see him. >> is he was. you were here all day, he was

here. >> any further discussion? if not, the vote will occur on the motion by mr. sessions. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> recorded vote, please, madame chair. [roll call] >> the clerk will report the totals. the motion is not agreed to. mr. sessions. >> thank you, madame chair. i i have an amendment to the rule and move that the committee make an order to provide the appropriate waivers for amendment number 61 offered by the gentleman, mr. burgess, of texas, who was here this afternoon, most of the day, which would have a division based on the medical liability reforms adopted in that the state of texas. >> thank you, mr. sessions. you've heard the gentleman's motion. any discussion? if not, if ochres -- stand yes,

madame chair. it's my understanding that by accepting this amendment, the bill related to the deficit would be reduced by cbo score of a minimum of $50 billion in here. i think that this would be a good thing to add. we are worried about the availability -- all of us i think of the ability to use physicians who will handle the types of cases and things which they have been trained to properly provide for. as a result of the state of texas moving forward with state law that was very similar to california, the state of texas which operates a lot of medical schools received in one year the equal number of people that were in the entire medical schools system in texas, those numbers of physicians who left the states which they were in and came to texas which resulted in

a very large opportunity for texas to help its on insured populations. we had physicians up and down the state's many times in rural areas. many times with physicians with high risk problems the state of texas but added greatly. it's not only helped access, it helped poor people, it helped senior citizens, it helped disabled people, and it is a wonderful, wonderful attribute in keystone product to what most health care organizations and physicians' organizations believe has made texas a lot better, and i believe it would be a great thing to add to this bill medical malpractice for the tune of $50 billion a year. >> you heard the gentleman's motion and discussion. any further discussion? if not, the voters on the motion by mr. sessions. all in favor, say aye. opposed, no. in the opinion of the chair, the

noes have it. >> madame chair on behalf of mr. burgess and myself i would ask for a recorded vote three >> recorded vote, please. [roll call] >> [inaudible] [roll call] >> the clerk will report the totals. the motion is not agreed to. mr. sessions. >> madame chair, thank you. i have an amendment to the rule and move that the committee make an order to provide the appropriate waivers for amendment number 69 an amendment number 80 offered by the gentleman mr. rauf of texas, amendment number 69 will require a social security number for eligibility for participating in exchange and amendment number 80 would require a valid seóul i.t. when applying for medicaid or schip. >> you heard the gentleman's

motion. any discussion? mr. diaz-balart? >> i would like to point out again while to much of the chagrin there are ample requirements that prohibits undocumented immigrants from purchasing insurance through the exchange, and i would point out that any requirements for additional documentation or efforts to prevent undocumented immigrants cost the taxpayers additional money to pay for illegal immigrants and that is what the whole amendment would do. i yield back. >> any further discussion? >> if this meant that were made in order i would vote against it. , but as strongly as i disagree with it, i think that the house should have an opportunity to get to voice its will. >> thank you, mr. diaz-balart. any other discussions? if not, the focus on the motion by mr. sessions through it all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> madam share, recorded vote, please. >> recorded vote. [roll call]

>> the clerk will report the totals. the motion is not agreed to. mr. sessions. >> madame chair come say thank . i have an amendment to the rule and move that the committee make an order to provide the appropriate waivers for amendment from mr. g sam johnson which would strike the individual mandate exception for a legal immigrants. >> keefer of the gentleman's motion. is there any discussion? >> [inaudible] will again, they are not allowed to purchase insurance through the exchange, so it doesn't make any sense to do both here where this would presumably require them to have coverage and ban them from acquiring coverage, so it's just somewhat incoherent with the statute as referred to by the senate and i yield back.

>> mr. diaz-balart. >> i agree with mr. polis. but i think that as ill-conceived as the amendment is, it's still something that should be able to be considered by the house and i would vote against. >> any other discussion? if not, the vote occurs on the motion by mr. sessions. all in favor, say aye. opposed, no. in the opinion of the chair, the noes have it. >> recorded vote, please, madame chair. [roll call] >> the clerk will report the totals. the motion is not agreed to. mr. sessions. >> thank you, madame chair. i have an amendment to the rule and move that the committee make an order to provide the appropriate waivers for amendment number 14 offered by the gentleman, mr. stearns of florida which would require the coequal heads of the three branches of government, the

president, congress and supreme court justices to enroll in the health exchange. >> you have heard the gentleman's motion. any discussion? if not, the focus on the motion. all in favor, say aye. opposed, no, in the opinion of the chair come the noes have it. >> madame chair, i have come to the proper one now, and that is the last one as dr. foxx says. i have an amendment to the rule and move that the committee make an order to provide the appropriate waivers for amendment to be separately debated for ten minutes each and considered. amendment number 105 offered by the gentleman, mr. hinojosa of texas, which would add a pulled harmless amendment for those hospitals that serve high poverty areas and are subject to reductions under medicare and medicaid disproportionate share hospital payments that would require mudpack to conduct a study that determines the

continued copper will be of hospitals and the high poverty areas, the secretary of health and human services would enact recommendations based on the study and ensure continued access to care by individuals served by such hospitals. also amendment number 92 offered by the gentleman sheila jackson lee of texas which would strike medicare limits on expanding physician owned hospitals. amendment number 93 offered by the gentle woman represented jackson lee of texas which would provide an exception to medicare limits on physician owned hospitals by providing an exception for safe hospitals that meet criteria for disproportionate share of hospitals or high number of the emergency room visits. further, amendment number 94 offered by the gentleman jackson lee of texas, which would amend the definition for high medicaid facility. ..

[roll call]

>> the clerk wilbert port the total. the motion is not agree to. >> before we turn to ms. foxx i would just like to say, while we have gone through an extraordinarily intense 13 hours here, that's i would like to have a light moment if ever be possible to say that in one hour, mr. sessions will be celebrating his birthday. i wanted everyone here to know that. [applause] thank you very much. now we can turn to ms. foxx. >> ms. foxx. >> thank you madam chairman. before i offer an amendment i would like to say in light of the discussion on the amendments we have had tonight, i would like to ask at the chair provide us with a number of amendments for the first session and this session so far that have been offered in person and those offered without the person

testifying by majority party and minority party, and the percent of each of the amendments-- of those amendments that were accepted. i would like to see the statistics on this. when you all raise questions, i guess it is my academic background. you got me to@@@@%7r

staff and considerable work. how long did you want to go back? >> just this session, but the first half of the session. the first session and then the second session. it is a 111th congress i should say. >> let us see what is possible. >> again, you have raised the issue tonight in terms of whether your percentage is

better or worse if you attend. it might be kind of interesting to show that two people. madam chair i have an amendment for the rule. i moved that the committee make in order to provide the appropriate waivers for amendment number 6 offered by representative foxx of north carolina which would strike the entire student aid and fiscal responsibility act. >> i'm sorry, i didn't hear. to strike that? alright. >> you all heard the motion. >> again i would just like to emphasize that the safra adds pass both my committee as well as the house with a strong bipartisan majority. it helps make college more affordable for young people and streamlines the loan program and contributes to the deficit reduction better part of this entire package and help reduce our federal debt going forward. >> is there any discussion? >> i would just like to say there are parts, had the

amendments been more tailored, that might've been interesting to me but it is far too broad. >> any discussion? if not the vote occurs on the motion. all in favor, say aye. opposed, no. record the vote. [roll call] >> the clerk will report the totals. the motion is not agree to. ms. foxx. >> madam chair i move the committee make in order to provide the appropriate waivers for amendment number 98 offered by representative round of georgia, franks of arizona and sam johnson of texas which would provide nothing in the protection and affordable care act or this act may authorize or permit access to or coverage of

abortions except in the case of a woman who suffers a physical disorder, physical injury or physical illness that would as certified by a physician plays placed the woman in danger of death unless an abortionist performed or if the pregnancy is the result of an act of forcible rape or. >> you have heard the gentlelady's motion. any discussion? if not, the vote occurs. all in favor, say aye opposed, no. [roll call] >> the clerk will record the totals. >> thank you am chair. i've moved that the committee make in order to provide the appropriate waivers for amendment number 67 offered by representative around waite of

florida which would repeal the sections of the bill that required the irs to enforce the individual mandate. spieler for the gentlelady's motion. any discussion? if not the vote occurs on the motion. all in favor say aye. opposed, no. >> madam chair could we have a recorded vote? [roll call] >> the clerk will report the totals. >> madam chair at the amendment to the rule, i move the committee make in order to provide the appropriate waivers for amendment number 13 offered by representative black man of tennessee which would prohibit the federal government from passing any law that the given authority to ration health care for the american people. >> you have heard the gentlelady's motion. is there any discussion?

if not, the vote occurs on the motion. all in favor, say aye. opposed, no. the no's have it. >> a recorded vote please. [roll call] >> the clerk will report the totals. >> madam chair an amendment to the rule. i've moved the committee provide the appropriate waivers for amendment number 90 offered by representative roskam of illinois which would strike the current section 1302 central health benefits requirement and replace it with a new section, medicare waste, fraud and abuse prevention pilot program. spieler for the gentlelady's motion. any discussion? all in favor, say aye. opposed, no.

>> a recorded vote please. [roll call] >> the clerk will report the totals. >> madam chairman an amendment to the rule. i move the committee make an order in pride the appropriate waivers offered by representative kingston of georgia which was would suspend attacks is must medicare fraud is below 1%. >> you have heard the gentlelady's motion. any discussion? if not we will vote on the motion. all in favor, say aye. opposed, no. it appears the no's havoc. >> a recorded vote. [roll call]

the clerk will report the totals. the motion is not agreed to. >> an amendment to the rule. i've moved the committee make in order provide the appropriate waivers for amendment number 11 offered by representative lee of new york which would create a three year/five state tribunal pilot program to be administered by the secretary of hhs. >> you have for the gentlelady's motion. any discussion? all in favor, say aye. opposed, no. the no's have it. >> can we have a recorded vote? [roll call] >> the clerk will report the totals.

>> madam chair of an amendment to rule. i'm of the committee make in order provide the appropriate waivers for amendment number 44 offered by representative role of tennessee which would repeal the enactment of independent data care advisory board. >> you have heard the gentlelady's motion. any discussion? discussion? the vote occurs on the motion. all in favor, say aye. opposed, no. madam chair the no's habit. >> a recorded vote. [roll call] the clerk will report the totals. >> i have an amendment to the row. i move the committee make in order provide the appropriate waivers for amendment number 29 offered a representative gingrey of georgia which would state that nothing in the legislation shall be construed to allow any

federal employee or political appointee to dictate how a medical provider practices medicine. >> you have heard the gentlelady's motion. any discussion? all in favor, say aye. opposed, no. madam chair the no's have it. >> record the vote please. [roll call] >> the clerk will report the totals. >> madam chair ivan amendment to the row. i move the committee make in order provide appropriate waivers for amendment number 17 offered by representative stearns of florida which would require that any written visual or audio materials distributed through a official entity or program shall be in english only.

in english only. >> you have heard the gentlelady's motion. any discussion? >> that is stretching me. [laughter] i vehemently would oppose that amendment on the floor. [laughter] and it really makes absolutely no sense. but, since i've followed the philosophy of allowing, supporting, allowing the entire house to work its will, i will even vote for something as absurd as this. [laughter] to be made in order. >> will the gentleman yield? i think he makes a very important.. it is easy to laugh at the notion of someone saying that they vehemently oppose an

amendment and still believe that the idea of allowing the house house to have a debate on what he believes to be a stupid idea is fair, and i will say that we are in the majority. i often supported making an order amendments for which i totally disagreed, so i think this is a very, very clear position that the gentleman has because he supports the notion of openness and transparency and i believe he is absolutely right to say that he opposes the amendment that supports a members right to be heard on the amendment and i thank my friend. >> thank you. >> if no other discussions of vote will occur on the motion. all in favor, say aye. opposed, no. madam chair, the no's have it. >> record the votes, please. [roll call]

>> the clerk will report the totals. >> the motion is not agreed to. >> madam chair i move that the committee make in order to provide the appropriate waivers for amendment member 22, amendment number 23 offered by representative sullivan of oklahoma. amendment number 22 wood required the hhs secretary to conduct a study on new and old programs affected by this legislation to determine if there is any program duplication , write a report on the study within one year and after writing that report the secretary would be required to eliminate any duplicative programs within one year. amendment number 20 theory would require the secretary to conduct a study on new and old grant programs affected by this legislation to determine if there is any program duplication

or write a report on the study within one year of the enactment of this bill and after writing that report the secretary would be required to eliminate any duplicative programs within one year. >> you have for the gentlelady's motion. is there any discussion is not the vote will occur on the motion. all in favor, say aye. opposed, no. madam chair the no's have it. >> could we have a recorded vote? [roll call] >> the clerk will report the totals. >> thank you in a chair. ivan amendment to the row. i've moved the committee make in order to provide the appropriate waivers for substitute amendment number 21 offered by representative terry of nebraska which would establish the citizens congressional health

benefits program. >> you have for the gentlelady's motion. is there any discussion? it's not the vote will occur on the motion. all in favor, say aye. opposed, no. madam chair, the no's have it. speak and we have a recorded voteãa by mrs. foxx.

all in favor, say aye. opposed, no. madam chair the no's have it. >> can we have a recorded vote, please? [roll call] the clerk will report the totals. >> i have an amendment to the row. i'm of the committee make in order to provide the appropriate waivers for amendment number 7 offered by representative lachman of tennessee, which would provide nothing in the actio preclude an individual from purchasing or maintaining insurance qualifying for health

savings account deposits and nothing shall interfere with their ability to continue to make deposits according to the schedule created in the 2006 hsa legislation. >> you have heard the gentlelady's motion. any discussion? if not the vote occurs on the motion. all in favor, say aye. opposed, no. madam chair, the no's have it. >> can we have a recorded vote? [roll call] >> the clerk will report the totals. >> the motion is not agreed to mrs. foxx. >> i have an amendment to the row. i'm of the committee make in order provide the appropriate waivers for amendment number 63 and 71 offered by representative walden of oregon.

amendment number 63 would ensure proportional representation of interest of rural areas on independent medicare adviser reports and independent, and amendment number 71 would ensure that medpac has adequate. [roll call] representation. >> you for the gentlelady's motion. is there any discussion? mr. cardozo. [inaudible] . . .xd it. a e ai [roll call]

>> the clerk will report the total. the motion is not agreed to. >> madam chair i have one more amendment that before he do that i would like to put into the record and article dated december 23, 2009 by the chairwoman called the democrats view from the house, senate bill is in reform. i would like to enter this into the record. >> without objection. do you have another amendment? d. i do. madam chair ivan amendment to the row. i'm of the committee make in order provide the appropriate waivers for amendment number 9 and number 10 offered by representative moore of wisconsin which would change the date when insurers would need to comply with the new medical loss ratio requirements from 2011 to 2014 to conform to win the american health benefits exchanges will be established. >> you have for the gentlelady's motion. any discussion?

is not the vote occurs on the motion. all in favor, say aye. opposed, no. >> can we have a recorded vote madam chair? [roll call] >> the clerk will report the totals. the motion is not agreed to. mr. dreier. >> let me just say we have gone through and dispense with the amendments by both democrats and republicans to this committee. it was 13 hours and 20 minutes ago that we began this hearing. we considered, how many members are you counting up there? and it seems to me that tomorrow is going to be a very, very interesting day for this institution and i know there are a lot of people who believe what we are going to be doing, if we

see the house of representatives pass this measure is move towards something that they believe to be the right thing. i am very, very troubled as i know my other colleagues the minority on this committee, are concerned about the direction in which we are moving. we all, we all very much want to ensure that every american has access to quality, affordable health insurance and the notion of expanding the size and scope and the reach of government as we may be poised to do is extraordinarily troubling, so i'm going to urge my colleagues as we move towards the motion before us to vote no so that we can get back and have a rule that would allow for free-flowing debate and the kind of legislation that i believe will go a long way towards addressing the goal that we all share.

>> i just want to take this moment to tank of the chairwoman for her leadership of this committee during this long debate, and markup, and i was a history major in college. this is one of these moments that we look back with great pride. we look back at the debate on social security and medicare, the same kind of opposition that was made. and, i think we look back on those things and people are glad that the members of congress and the president had the guts to actually move forward on this and i think this is one of those moments. i think we all wish that, some on the other side would not have thrown up so many roadblocks and we could have done this and conference but look, we need to do this. we have been trying to do it for decades and i think we are about to make history tomorrow and i want to thank the chairwoman and

all the members of the committee and staff for their patients and i look forward to tomorrow. >> thank you. now that we have ended the amendment that at may 1 to wish a happy birthday to mr. sessions. you have been with us all day and we thank you for that and we thank all the press that has covered us, and i want to say i am so happy to be here at this time. i went through the clinton health care plan. it was tragic that we did not pass the. we would have been so much better off now in so many ways. i think 45,000 that died a year of now without health insurance, that alone might not have happened. but tomorrow, i have a the great honor of reading that franklin roosevelt speech on health care. i have gotten a copy from the national archives. it was typed on a white house

typewriter and have some of his notes, handwritten notes on the sheet. this of course is a duplicate. the original will go to hyde park, but i am so pleased just looking at it. it brings back wonderful memories of a man who had the courage of his convictions and put this country back on its feet. so, i thank everybody here. i look forward to it, and i can't help but think of all the stories we have heard today. people who are suffering out there and you have nobody else to count on let us. and tomorrow, i ask that every man, woman and the house of representatives to his and her duty. the last those will be on a motion by mr. mcgovern. calling the vote by mr. mcgovern. >> aye.

>> opposed, no. let's have a record vote. [roll call] [roll call] >> yes. the clerk will report the totals. this is agree to and i am so happy about it. i look forward to tomorrow. tonight we have voted 80 amendments. i don't know if that is a record or not but while we are checking on it at mrs. foxx's requests, and maybe we can find that. i will be carrying this for the geordie tamara. thank you all very much. this committee is now adjourned.

[inaudible conversations] [inaudible conversations] óñc

>> the president has said over and over, we will measure our own success on the progress that has been made by america's working families. that is our responsibility. we will honor it when we vote on healthcare reform. we will not be there without the presence of my colleagues here.ñr this willjf be about wellness a prevention and making america healthier. we would not be here without your inspiration, leader shi, fresh thinking on this subject. we thank you on that leadership.

he had said at the time of his wife's accident that it even made him further aware of why we must pass this bill because it's so important for all americans to have the sake access that she has. to watch him on a day-to-day basis is to see a master at work. a vision for america and a knowledge of the procedures. i'm scre, very pleased to thank him for what he has done and introduce to you, my cool eerks the great leader of the united

states gnat. harry reed. [applause]

i'm happy to announce, i have the majority commitment to make

that good law even better. >> our great country has needed health reform for nations. this congress has been focused on it for the entire past year. history will show this will be one of the most important years of our history.

>> mr. president, i know you know basketball. you are a big fan. many are fixed on the basketball tournament nowñr we are in the last minute of play, the shot clock is turned out. the other side knows what the outcome will be. they are trying to foul us and foul us and foul us again just to keep the clock from saying zero. every time they foul, we'll keep hitting our shots. we'll overcome every obsticle l they throw in ourñi way. soon, they'll be a clear winner. that winner will be the american people.

america is watching us. some would saying this a partisan effort. they are wrong. this is an effort on behalf of all americans. george w. bush said "all americans should be able to choose a healthcare plan that meets all their needs." bill clinton said, "it's time for us to worku]ñ together." george h.w. bush said, a national health insurance program is one of the major unfinished items on america's social azpwenda. the american people, he said in 1992 have waited too long. gerald ford said let us affirm

that this national legislation is only a part of our effort, so no individual in this country will lack help whenever or wherever he need it's. our nation must do more to reduce the impact of accident and disease. two fundamental problems confront us. first the high and every rising cost of health services. serious gaps and shortages in those services millions of our

citizens do not have the full measure of opportunity to achieve health. time has arrived for action to help them attain that opportunity and protection. comprehsive health insurance is an idea whose time has come in america he urged us to act sensiblely he urged us to let

us act now in 1974 to assure all americans financial access to high quality medical care theodore roosevelt put this on the agenda barack obama reached out and said, this is what i will do in the debate of october 2008. he said what he was going to do. john mccain stood on the same stage and said, yes, i believe every american should have access to affordable healthcare. all the presidents tried get something done.

it was not done. on sunday we will do it. this is our moment. ladies and gentlemen, the president of the united states, barack obama. thank you. thank you.

[applause] . please have a seat. to leader reerd. to john all-star son, jaffier, jim, chris.?3ñ

i came upon this quote by abraham lincoln. "i am not bound to win but i'm bound to be true. i'm notbound to succeed. but i'm bound to live up to what life i have. this has been a difficult process. this has been a difficult year for the american people whether i was sworn in, we were in the midst of the worst depression. 800,000 people per month were losing their jobs. millions were losing their health insurance. the financial system was on the

verge of collapse not because you were bound to win but because you were bound to be true each of you made a decision that it was less important to measure what the polls said than to measure what is right. a year later, we are in different circumstancestyj.

>> we have known millions are living their own quiet crisis. whoever they called, they couldn't get coverage for that child. maybe it had been somebody who had been forced into early retirement in their 50's, not yet eligible for medicare. they couldn't find a job or

health insurance despite the fact that they had some sort of chronic condition that had to be tended to. every one of you before congress or after have met constituents with compelling stories. you looked them in the eye and said we are going to do something about it. now, we are on the fresh hold of doing something about it. we are a day away.ur 

how will this play out in november. is this good or is this bad for the majority. what does it mean for those i notice there's been a lot of friendly advice offered. mitch mcconnell, john boehner, karl rove. they are all warning you of the hor end youse impact if you support this legislation.

it could be that they have suddenly had a change of heart and they are deeplyñi concerned about their democratic friends. this year, small businesses will start getting tax creditsñ

insurance companies won't be able to drop your coverage when you get sick they also know what won't happen.

there's no government take over pefment will discover that if they like their doctor, they'll keep their doctor because of a stronger system turns out this is a bill that tracks not only

recommendation of tom daschle but republicansñ this is designed to help people in an area of their lives where they urgently need help the republicans want the foxes guard the hen house approach. let them run wild under the notion that this was going to run the cost for americans.

it is working for middle class families what did we do? number one, this is the toughest insurance reforms in history. we are making sure that the system of private insurance works for ordinary families making sure employers if they are paige prepare yums that their employees are getting the coverage that they expect. insurance companies are not going to gain the system with

fine print that's number one. the second thing this does is it creates a pool. a marketplace, where individuals and small businesses who right now are having a terrible time out there getting edge insurance. they'll be able to pump health insurance as part of a big group just like federal employees, members of congress. they are now going to be part of a pool who can negotiate for better rates, better quality, more competition. that's why the budget office says this will lower people's rates by 14-24% that's not my

numbers. people will have choice and competition if people still can't afford it, we are going to provide them some tax credits number four. this is the biggest deficit reductions in history over 1.3 trillion that the delivery

system is5(a working for patie and not just billings.8x7 that's what this effort is all about reduction in the cost of healthcare including those who have healthcare we pay for it

responsiblyly in ways that the other side of the aisle that talks a lot about fiscal responsibility but doesn't seem to walk the walk can't claim we are actually doing it. this is paid for and will not add a dime or reduce the deficit. is this bill perfect? will this solve every problem right away? no.

i know there was a meeting to assure that we can try to make sure there's a system that gives people the best bang for their buck. there are all kinds of things in this legislation. the single most important step that we have taken on healthcare since medicare, absolutely is this the most important piece of legislation that's given us a break? absolutely. is this a vast improvement over

the status quo, absolutely. i know this is a tough vote. i've talked to you individually. i have to say that if you honestly believe in your heart of hearts, in your conscience that this is not an improvement over the status quote. if despite all the information out there that says without serious reform efforts like this one, people's premiums are going to double, that folks will keep on getting letters saying that their premium just went up 40 or 50%. if you think that somehow it's ok that we have millions of hard working americans that can't get healthcare.

that it's acceptible that in the healthiest nation on earth if you agree this system is not working for ordinary families don't do it for me don't do it

for nancy or harry. some of you know i get 10 letters a day i read out of the 40,000 i receive. started reading some i got this morning. dear president obama, my daughter, a wonderful person. lost her job. she has no health insurance. she had a blood clot in her brain, now disabled. can't get care. >> i don't yet qualify for medicare, cobra is going to run out. i am desperate. don't know what to do. do it for them. they find out that because of an accident or ailment, they

are about to loose their house where they can't provide the help for their kid that's they need. they are the ones looking for action right now. [applause]

i believe you'll dot right thing. i believe the policy is good politics. i am convinced when you go out there and you are standing tall and you are saying that i believe thatxd this is the righ thing to do that ultimately, the truth will rule out. i had a wonderful conference with betsy. betsy is in a tough market. the biggest newspaper is some what conservative. they weren't really surprised. betsy, despite the pressure announced that she was in favor of this bill the next day, that

newspaper runs an article that says you know what, we have considered this. we are pleased that the congresswoman is supporting the legislation. [applause] when i see some stand up, proud with a whole bunch of hisñr

constituents in as tough a district as there is and stand up with a bunch of folks from his district with preexisting conditions saying i don't know what's going on in washington but i know what's going on with these families. i look at him with pride. i can't guarantee that this is good politics. everyone of you know their districts better than i do. you are getting calls and emails tying up the communication systemxd i've bee in your shoes.

i've had a few comments about me. what can we say? i am not bound to win i'm bound to be true. we are going to make sure that seniors and the poor have coverage. i'm sure that they weren't sure what the politics were either. anymore thant people who made sure how social security took place or folks who passed the civil rights act knew how the politics were going to play out. they were not bound to win.

they were bound to be true. now, we have middle class americans don't have medicare, don't have medicaid, watching the system, being caught in terrible situations. we ask are we being true to them. we ask how we got involved in politics. i went to work with poor chatholic churches in chicago i was skeptic kell of politics

and politics folks in elected office are not looking out for themselves. the special interest have too much power. they just have too much clout. too much big money washing around.v(t i decided to get involved. i realized if i tude up, then the system wouldn't change. every single one of you had that same kind of moment at the beginning of your careers. maybe it was just listening to stories in your neighborhood about what was happening to people who had been laid off of work. maybe it was your own family experience.

you said something should change. something inspired you to get involved. something inspired you to be a democrat instead of running as a republican. somewhere deep in your heart, you said i believe in america in which, we don't just a lookout for ourselves. we don't just tell people we are on our own. we have a sense of community that's why you decided to run

that's why you decided to run. now a lot of us have been here a while. everybody here has taken their lumps and bruises. it turns out people have had to make comprimises. you've been away from family for a long time. you've missed special events for your kids sometimes. you ask yourself why did i get involved in politics anyways.

you say maybe that thing that i started with has been lost. every once in a while a moment comes where you have a chance to vindicate all those hopes you had about yourself, about this country you have a chance to make all those breakfasts and traveling through the district. this is one of those moments. this is one of those times you

can honestly say to yourself, this is exactly why i came here.bfj this is why i've got into politics. i believe so deeply in this country and dem crassy i'm willing to stand up even when it is hard, even when it is tough. we are not bound to win but we are bound to be true we are not bound to succeed but let whatever light that we have shine it is time to pass

healthcare reform. i am confident you are going to do it tomorrow. let's get this done. [applause] let's fire it up.

fire it up. >> following their meeting, house republicans spoke outside. this is about 10 minutes. >> house republicans just completed our special meeting of our conference house

republicans are determined to stand with the american people and oppose healthcare with everything we've got. it's important as this administration take over with hundreds of billions of dollars of higher taxes and mandates through the congress. it's important that they understood that it is not the president's house it's not the speakers house, this weekend, we will stand with the american people to stand with power and bring about healthcare reform that gives them more freedom and not more government house

republicans remain committed to do everything we can to defeat this healthcare bill. i thank all americans that have come here to join us in this fight if we continue to work hard, we can defeat this bill. the real question is are representatives listening to america? we are elected to represent people all across this country. yet we see poll after poll where americans are saying we

don't want this bill. we don't likeçó government-run healthcare. the answer for tomorrow is whether or not representatives are listening. we are here to stand with the american people. we thank everyone for coming here and standing with us. yesterday, the speaker had a press conference. she showed she sent a bill to cbo, she got a score back. you can manipulate a bill and a score. the speaker said we are going to pass what they call the dock fix. cbo said if that's true, your bill has a huge deficit. just adding the dock fix makes this a $58 billion deaf stit we

are double counting rds 70 they are not countying what is necessary to run this government-run healthcare. $398 billion just from medicare part a 0 add all this up. the point is this. this bill gives us a massive deficit the entitlements we

already have are affordable. we are already $76 trillion in the hole. they don't now have the votes for it. i sure hope they won't. i represent west virginia. healthcare is on the minds of everybody standing here. this is amilingts opportunity. i'll tell you another thing on everybody's mind. that's jobs.

jobs in our families and communities. in this bill, there are taxes totally $569 billion. job killing taxes at a time when we can least afford losing one single job across this country people will be sadly disappointed each and every one of us on small businesses and across the country. after this passes. it's going to become more

popular. they are dead wrong. how about the seniors down there. you are going to ski a lot of them how about the small business owner who will see higher taxes, do you think it will become more popular with them? at a time when americans are asking where are the new jobs? this is not the way to go and the american people know it. i sent a letter to the speaker asking her to have a call of the house. a roll call vote straight up or down vote. having these men or women here in the congress stand up before god, their country and announce

their vote. we have to work to make sure we never, ever let thex pass this bill. thanks. >> trying to persuade them. our members are talking to their undecided members and doing telephone town hall meetings into undecided town

hall districts. there's more going on than what you would see in a normal campaign. this time tomorrow, houment will you turn? >> i don't know, it's going to be a very, very close vote. this healthcare bill will ruin our country. it's time to stop them. now vote.

>> julie from national public radio. there's been a development in the house they are going go

ahead and have three votes. even though republicans and democrats have done it many times that makes it easier to get those votes. it's ok to make those changes.

some democrats were saying they really didn't want to do the process that way. there were a lot of member that's didn't want to vote on that bill. >> i think that would seem to be the case. the house majority leader came out they have been saying we will have the vote when's we take the vote. for the first time, majority leader said we are confident we have the first vote. it would seem that they think they have the votes. being able to structure the vote that way does make it easier.

they will already have voted on the changes they make to that bill. the last we've heard is that those talks have broken down. it would seem they don't need thosexd votes. there are a lot of opponents that said they will vote on this bill. that senate bill hasen dossed a lot of opponents. there are a number of abortion opponents that say the senate bill does prohibit federal abortion funding it's not clear that they need that block of votes this was talk that the

president might issue an executive order they believe that the senate bill already does that. there might be some discussion there might be some discussion you can track on.