market a large pool in which to have a lower price? they're gone. oh, i see, you can have an association -- i spent eight years in my life chasing after association health plans that were frauds. they were out and out frauds. sold across state lines. is that what you want? apparently so. i don't get it. i don't understand what the goal is here. the affordable care act establishes an exchange allowing individuals and small businesses to be part of a large pool, to have four different options on their insurance and you want to do away with it. i don't get it. you want to do away with clinics in schools so kids can have access to health care. you cut the money pr community clinics so people have to go to emergency rooms in a more expensive situation. what's this all about? i don't understand what the goal is that our republican colleagues have in mind. the exchanges make sense. they create a marketplace for small businesses. thank you very much, mr.

speaker. . it is a market driven program in which competition occurs. they have to offer quality and price. you got a problem with competition? apparently so. you want to do away with the exchange? apparently what you want to do is hand the entire game over to the insurance companies, removing all the controls, all the necessity for them to compete and apparently create some sort of association plan so the republic can be ripped off. i yield back. the speaker pro tempore: members are advised to address the comments to the chair, not to each other. the gentleman fromical reserves. the gentleman from new york is recognized. . >> i yield one minute to my colleague from tennessee, mr. roe. the speaker pro tempore: the gentleman from tennessee is

recognized for one minute. mr. roe: in tennessee, 17, 18 years ago now tried tenncare, with sort of an exchange. we had seven or eight different plans competing for your business. and in 10 years the cost tripled in our state because of the intervention of the government. medicare i want to speak to that quickly. if you are 65 years of age and you have medicare, you keep it. if you're 55 with the ryan plan goes through, you keep it. if you are younger, you are requesting to pay more for your health insurance. yes, you are. if you are someone with my with a higher income, you are. if you are lower income and sick, you're not. your federal government will act like your employer does if you have employer-based insurance. that part of the premium is paid by them. you pay your part of the premium. again it will be means tested for higher income senior. why do we think that will work? the only federal -- the only plan that i have seen this government ever pass that's come in under budget is medicare part

d. so i think there's a real chance for this help hold costs down. i yield back the balance of my time. the speaker pro tempore: the gentleman's time has expired. the gentleman from new york reserves. the gentleman from colorado is recognized. mr. polis: i'm happy to yield two minutes to the gentleman from colorado, mr. garamendi: the gentleman from california is recognized for two minutes. mr. garamendi: let's be clear about this. the republican budget proposal that is before this congress terminates medicare as we have had it since 1942. for those young men and women who are not yet 55, they will never see medicare. it's over. and instead of having medicare which is a guaranteed health insurance program, when they retire at the age of 65, they will be given a voucher that will be worth a percentage of what the insurance will cost. they will be thrown into the market at an age where they have pre-existing conditions. under the republican proposal

there are no, there are no ways in which they are going to be protected from the insurance companies who we know have one motive and that is profit before people. profit before people. mr. roe: will the gentleman yield? mr. garamendi: from the get-go. that's precisely what the republicans want to give us. we will not have it. mr. roe: will the gentleman yield? mr. garamendi: they want to take those reductions in medicare expenditures and continue giving money to the most wealthy people in america. i will not yield. so that the most wealthy people in america can continue to enjoy ever more wealth while the middle class enjoys ever more poverty. it is an abomination and there is no way this nation should abandon a proven program that for 42 years has provided quality medical care to the seniors. now, you want to go after the cost of medicine, then let's go after the overall cost of

medicine. not deny tomorrow's seniors the benefit of medicare. it is time to understand precisely what the republican budget does. it terminates medicare while giving benefits to the most wealthy americans. it should not happen. i yield back my time. the speaker pro tempore: the gentleman from colorado reserves. the gentleman from new york is recognized. >> do we have any other speakers on the other side? mr. polis: we have no remaining speakers. the speaker pro tempore: the gentleman from new york is recognized. >> i reserve my time. the speaker pro tempore: the gentleman from colorado is recognized. mr. polis: thank you, mr. speaker. i want to further discuss the benefits of school-based health centers. a wide range of research and evaluations have demonstrated that school-based health centers are cost-effective investments in our nation's health care safety net for children and

adolescents and also help improve academic performance. each program is different as they should be. some of the services often include things like well child and well adolescent exams, immune cases, treatment for illness or injury. including management of chronic conditions like obesity, diabetes, asthma. they also frequently include services like mental health assessment and treatment. prevention programs to help reduce smoking, to help reduce teenage pregnancy rates, to help reduce violence. they frequently include substance abuse counseling, nutrition counseling, as well as dental cleaning. these are services that prevent costly emergency services and hospitalizations later and help keep kids in school where they should be, learning. most importantly, stronger school-based health centers lead to stronger, more successful children and adolescents across the country. by bringing health care services to children where they spend most of their day, at school,

school-based health centers are a sensible and inexpensive way to deliver basic health care services to children all over the country. this unwise legislation undermines our fiscal condition by wasting an opportunity to leverage local funding. providing capital support to school-based health centers is a federal investment that is a good deal for taxpayers. that's because when we provide modest federal support to school capital projects, local and state funding in partnership with nonprofits and community health clinics is spent on operating activities, staffing, and other equipment. what a great value for our federal dollar. likewise the value of this federal investment helps the local districts, many of whom can't build school-based health centers on their own. however many of these districts will benefit tremendously and the students and families from school-based health care clinics. the research is clear, mr. speaker, over a decade of studies consistently find positive benefits on school-based health centers.

these benefits include better student academic achievement, increased school attendance, and reduced tardiness among inner city children who receive counseling in the school-based health care center. fewer school discipline referals for students who receive mental health services, and increased learning readiness and parental involvement. as we discussed in this congress reducing the learning gap, helping all students achieve and ensuring that every american regardless of where they live has access to hope and opportunity through a quality education, school-based health care clinics are an important part of the solution. in colorado alone, there's 46 school-based health care clinics. in 18 school districts, including one in summit county school district, which i represent, which is applying for funding this program, and another applicant from eagle county, colorado. eight other colorado applications are going forward under this opportunity as they are throughout the nation. this is the initiative, mr. speaker, that republicans are seeking to eliminate.

they say they want a fiscally responsible budget and more jobs, but what we see instead is their priority is to stop programs that save money and create jobs and increase student achievement and learning like school-based health care centers. there can be no doubt about how the new majority is going about its business. there are no attempts to find common ground like we have in house resolution 9 and work on ways to improve health care or implement pooling mechanisms or allow purchasing across state lines of insurance policies, rather we are dealing with press releases disguised as legislation that will neither pass the other body nor be signed into law. that's not governance, that's immaturity. and the only americans being asked to sacrifice in the name of deficit reduction are those who have very little if not nothing left to lose. and no real way to fight back. that's not leadership. mr. speaker, we can and must do better. i urge my colleagues to oppose the rule and the underlying

bill. mr. speaker, if we defeat the previous question, i will offer an amount to the rule to provide immediately after the house adonts this rule it brings up h.r. 1366 the national managing strategy act of 2011. this bill will require the president to develop a national manufacturing strategy in order to boost traditional and high-tech manufacturing, spur american job growth, and strengthen the middle class. this bill passed the house on a bipartisan vote of 379-38 in the 111th congress. manufacturing is the cornerstone of our nation's economy. the u.s. government through its policies and programs has a major influence on our manufacturing base and national security, energy, and transportation systems rely on that base. we must unify the government programs, including in-- leading to increase efficiency and promote policies to promote our domestic manufacturing base to help our competitiveness in the global market. mr. speaker, i ask unanimous consent to insert the text of

the amendment in the report along with extraneous material immediately prior to the vote on the previous question. the speaker pro tempore: without objection, so ordered. mr. polis: i urge my colleagues to vote no and defeat the previous question so we can debate and pass jobs legislation today rather than legislation to increase the health care premiums that americans pay. i urge a no vote on the rule and the underlying bill. i yield back the balance of my time. the speaker pro tempore: the gentleman from colorado yields back his time. the gentleman from new york is recognized. mr. reed: thank you, mr. speaker. in closing on these two important bills that are now before this house, i say the 1213 and 1214 is dealing with an issue that the former speaker of the house envisioned when she said that during the debate on the underlying health care bill, obamacare, that congress needed to pass the bill so the american public could find out what's in it. we are finding out what's in it. these two bills will address provisions that dictate and mandate billions of dollars in spending. without any additional

congressional oversight. to me that is the critical piece. that is the critical piece why i urge my colleagues to support this rule and pass this legislation because this body, this body must stand up and adhere to its institutional responsibilities of controlling the spending of our country because we are broke. and that's what an army was sent here to do in november. and i'm proud to be part of that freshman class of 87 republican members of the house that are coming here and looking at every dime, every dollar that is being spent here in our nation's capital because our nation cannot afford it anymore and no longer will we pass the buck on to our children and our grandchildren so that they have to pay this bill that we are are no longer taking care of here in washington, d.c. i would say that what we are trying to do with this health care debate is put back into the debate in front of the american public the focus of this new republican majority and that is

we are going to deal with this problem by getting to the root of the problem. the root of this problem are increasing health care costs that are going through the roof. what we are dealing with here when we look at the underlying obamacare package is we are trying to minimize and mitigate health insurance costs. yet that's a piece of the puzzle but the crux of the issue and fundamental issue we face is the increasing cost of health care and that is what we are doing in this side of the aisle and we are focusing day and night to make sure that we engage in responsible oversight. we strip the mandatory language of spending that is being created out of these bills, and we go forward so that our children and grandchildren will have a greater future than we envisioned and enjoyed in our lifetimes. with that, mr. speaker, i urge the adoption of the this rule and i yield back the balance of my time and i move the previous question on the resolution. the speaker pro tempore: all time having been expired, the question is on ordering the previous question on the resolution. so many as are in favor say aye.

those opposed, no. the ayes have it. mr. polis: mr. speaker, i ask for the yeas and nays. the speaker pro tempore: the yeas and nays are requested. those favoring a vote on the yeas and nays will rise. a sufficient number having arisen, the yeas and nays are ordered. members will record their votes by electronic device. pursuant to clause 89 of rule 20, this 15-minute vote on ordering the previous question will be followed by five-minute vote on adoption of the

reconsider is laid on the table. the house will come to order. the house will come to order. the house will come to order. members will please take their conversations off the floor. the house will come to order. members, please take their conversations off the floor.

members will clear the well. the house will be in order. for what purpose does the gentleman from texas rise? >> mr. speaker, i ask unanimous consent that h.r. 1425 be re-referred to the committee on small business and in addition to the committee on science, space, and technology and armed services. the speaker pro tempore: without objection, so ordered. >> mr. speaker. the speaker pro tempore: for what purpose does the gentleman from michigan rise? >> first, i ask unanimous consent that all members may have five legislative days to revise and extend their remarks under the legislation that we're about to undertake and to insert extraneous material on the bill. the speaker pro tempore: without objection. >> and mr. speaker, i ask that the house be in order. the speaker pro tempore: the house will be in order. members take their conversations off the floor.

pursuant to house resolution 236 and rule 18, the chair declares the house in the committee of the whole house on the state of the union for consideration of h.r. 1213. the chair appoints the 1kwre89 from -- the gentleman from ohio, mr. latourette, to preside over the committee of the whole. the chair: the house is in the committee of the whole house on the state of the union for the consideration of h r. 1213, which the clerk will report by title. the clerk: a bill to repeal mandatory funding provided to states in the patient protection and affordable care act to establish american health benefit exchanges.

the chair: pursuant to the rule, the bill is considered read the first time. the gentleman from new jersey mr. pa -- the gentleman, mr. upton, and the gentleman from new jersey, mr. pallone, each will control 30 minutes. the chair recognizes the gentleman from michigan. mr. upton: i yield myself such time as i may consume. this bill is part of our effort to restore fiscal accountability to the federal government. in the rush to pass some kind, any kind of health care reform, the 111th congress enacted a massive law, 2,000-something pages that gave the secretary of h.h.s. unprecedented new authority. though it got little attention at the time, one of those new powers is an unlimited cap on the federal

secretary of h h.s. to direct appropriation of such sums as necessary for grants to states to facilitate the purchase of qualified health plans in newly created exchanges. shockingly, the congress gave an executive branch official the sole authority to determine the size of the appropriation. without further congressional action, the secretary can literally spend hundreds of billions of dollars at the secretary's discretion. the only limit is the secretary's imagination. given washington's reckless fiscal habits, americans concerned about record spending deficits and set debt have much to fear from section 1311a of that law. this power should never have been grant to one individual and it certainly should not be continued now. state a.g.'s have asked for an expedite red view of the litigation but this administration refused to let it happen. as a result, the future of the law remains murky. both supporters and opponents

should be able to agree that resolving the case expeditiously in the courts, the supreme court, is in the best interest of the country. but in the interim, we should not be spending billions of dollars, billions of dollars of taxpayers' dollars on something that might never happen. repealing the fund will protect precious taxpayer resources at a time of record red ink. rampant spending on the federal credit card is unsustainable and dangerous. the federal government is now going to be borrowing 42 cents of every dollar for these grants. $58,000 every second. think about that. we're facing a $1.6 trillion deficit and the president's budgets will nearly double the national debt from $14 trillion to $26 trillion. this program is a prime example of the hidden cost of the

health care law while the program itself, remember, was billed as costing taxpayers $2 billion, c.b.o. confirmed to us last year that repealing the program will reduce the deficit by $14 billion. that's because fewer americans will be pushed into the exchanges and a million more americans will retain their employer-provided health care coverage this bill is about accountability to taxpayers and fiscal responsibility in the congress. i would urge my colleagues to support the bill that will reduce the deficit by $14 billion. at this point, mr. speaker, i ask unanimous consent that all my remaining time be given to dr. burgess to manage the bill on the floor. the speaker pro tempore: without objection, the gentleman will control the time and the gentleman reserves. the gentleman from new jersey. >> thank you, mr. chairman.

i yield myself three minutes. mr. pallone: thank you, mr. chairman. this is another in the republican series of efforts to try to repeal the affordable care act. i will say other and over again how effective the affordable care act has been. we've already put in place most of the anti-discriminatory aspects of the affordable care act so people now can have their children up to 26 on their insurance policy. they don't have lifetime or annual limits on care. we've ended arbitrary rescission. we've given patients access to preventative services, without cost. we've gun the process of filling up the doughnut hole by giving seniors a $250 rebate and now a 50% discount on the

drug. the list goes on and on. people are starting to see the benefits of the affordable care act. but as you know, over the next two years, one of the

benefits is that we will now cover many americans. we have lower cost and health in pay -- an help in paying their premiums. the fact of the matter is the republicans want to eliminate all this. when they talk about brinning up a bill that would eliminate the grants or funding for the state exchanges, this is at the core because robust exchanges tailored to individual states it will be more difficult to do the things i mentioned that are a commitment to the affordable air contact. what i don't understand is that my colleagues on the other side of the aisle have been advocates for states' rights. the consequence of their legislation today would mean that states, 49 states an most of the territories have asked for these grants, would be denied these grants to set up state exchanges. most likely what will happen is rather than have a state exchange tailored to their own state and constituents, they will end up having a federal or national exchange. frankly, i don't have a problem with that. but if you're a state's rights advocate, which is what a lot of the republicans have been saying all along, why would you want to force the state to not have their own flexibility, not set up their own state exchanges and instead set up a federal exchange. the exchanges won't go away with this legislation. it's simply going to mean the states can't do a good job or they're going to yield that power to the federal government and you'll have a national exchange. this is the worst time to do this. as we know, states are hurting. they done have money. most of them have a crisis in terms of balancing their budget. why would you want to deny them

the money to set up the exchange? i'll give you an example in my own state. my own state applied for some of these grants, using it to do demographics to find out what kind of people they have, what their needs are, so they can tailor the state exchange in a way that's most effective to cover the most persons -- americans and provide good quality health care at a low cost. that's what this is all about. for the republicans today to bring this bill up in their effort to try to repeal the whole package, it makes no sense whatsoever. i don't understand it. they talk about mandatory funding, we have mandatory funding for medicare, for medicaid, for all kinds of things in this congress. all they're going to do with this is make it more difficult for the state to -- states to establish their own exchange. thank you, mr. speaker. the speaker pro tempore: the -- the chair: the gentleman from texas, mr. burgess. mr. burgess: i would remind the gentleman, the ranking member from new jersey in our committee hearing earlier this year, we heard from the

governor of utah, who had been setting up a state exchange prior to the passage of the affordable care act and now was left with an uncomfortable situation where it was ruled unconstitutional by two district courts, he's waived what happened to the court system. as he told us in committee, i'm walking on shifting sands, i no longer know where to go, the passage of the affordable care act has made my life infinitely harder. i yield two minutes to the gentleman from new jersey, mr. lance. the chair: the gentleman from new jersey. mr. lance: i rise in support of h.r. 1213. we currently have a debt in this country of $42 trillion and it's rising rapidly. the annual deficit will be $1.65 trillion, the largest percentage of gross domestic product since 1965. current levels of federal spending are uh sustainable. we cannot continue on this fissdal path we have been

traveling. to this end, the house energy and commerce committee has spent nearly the entire portion of its spring session identifying excess and unaccounted spending within programs, morely the president's health care bill. in an effort to decrease federal expenditures, in an effort to put our nation on a path of fiscal responsibility. this is one of the legislative fruits of the committee's efforts. according to the nonpartisan congressional budget office, passage of this bill to repeal the federal health care insurance exchange funding requirements would save american taxpayers $14 billion over the next 10 years. i urge my colleagues here in the house to pass this fiscally responsible piece of legislation that takes an important step in defunding the health care law and reduces federal spending and the deficit and i hope that at an early date the supreme court will rule on the constitutionality of the health

care law. i yield back the balance of my time. the chair: the gentleman yields back. the gentleman from new jersey. mr. pallone: mr. chairman, i yield four minutes to the ranking member of our full commrge and -- energy and commerce committee, the gentleman from california, mr. waxman. the chair: the gentleman is recognized. mr. waxman: we're not focusing on the big issues the american people care about with this bill. instead, what we have before us is not a bill to increase jobs or to help those lives torn apart in the recrevent natural disasters from the storms or to address the country's high energy costs. unfortunately, what the republican leadership offers up once again is a debate on the affordable care act. this is another piece of legislation that is going nowhere. the senate will never pass it and the president will never sign it. this bill, h.r. 1213, was

analyzed by the congressional budget office, and the budgetary estimate shows this bill diminishes coverage and raises costs. it punishes the states and hurts especially working americans and their families. first the bill will leave people uninsured. this legislation according to the congressional budget office will result in lower enrollment by an estimated 5% to 10% below the levels expected under current law between 2014 and 2016. in other words, there would be almost two million fewer people enrolled in state exchanges. secondly, it will increase the cost of employers as they continue to fight off a sluggish economy. third, it will increase costs to the consumers through increased peopleums in the individual market. four, without federal assistance fewer states will be able to set up and operate state-run exchanges. currently 49 states, the

district of columbia, four territories have gotten beyond the ideological debate that we are having over and over again in this house and they have responded by asking for funds so they can do the job of setting up a marketplace which would be best for families and businesses to choose their health insurance. fifth and notably, 85% of the total $14 billion in cuts come at the expense of low and moderate income americans. not being able to access health insurance through exchanges. it's time to stop debating bills that move the country in the wrong direction for political reasons. this bill takes a direct shot at the heart of health reform at the new marketplace it marks the end of insurance company abuses and puts americans in charge of health care. this is a wrong bill at the wrong time, it accomplishes nothing. we still don't know what the

republican proposal would be for health care. they said they were going to repeal it and replace it. we don't know what they would replace it with, but we do know that for the health care like medicare and medicaid, insures millions of americans, 24ir proposal -- their proposal would be to decimate those two programs. evidently they want to make sure states and working families don't have access to private insurance to choose the best deal for them and their families. i urge defeat of this bill. i yield back the balance of my time. the speaker pro tempore: the gentleman from -- the chair: the gentleman from texas. mr. burgess: i yield two minutes to the subcommittee chairman of the oversight investigation subcommittee, mr. stearns of florida. the chair: mr. stearns of florida. mr. stearns: i ask unanimous consent to revise and extend my remarks. the chair: without objection. mr. stearns: mr. chairman, two points that i have heard on the other side. one, they are talking about states' rights. it's really almost pathetic to

think they are arguing on states' rights because really the health care bill that they are advocating and the administration is advocating forces state government to pay for existing established exchanges. that's part of what the secretary of health and human service also do and she'll use this money which is unlimited to her to force states to pay for existing established exchanges. now, the other point they are saying why aren't we talking about jobs and focusing on this particular bill is not really getting us jobs, but this is focusing on spending. it's limiting spending. with the national debt of the united states just increased by $262 billion at the start of this year, we need to handle our debt here in this country and control spending. so i'm pleased we are taking up h.r. 1213 which would eliminate uncapped, unlimited programs in the patient protection and affordable care act, which is obamacare. this provision grants far too

much budgetary authority to the secretary of health and human services and far too little program retirements to in-- requirements to ensure proper oversight. that's why we need to pass this bill. this is fiscal responsibility. it's physically irresponsible to argue as they say to give any one individual unlimited mandatory spending authority. and that's what is in the obamacare. so i'm glad we have an opportunity to correct this legislative error. we must gain fiscal control over our government program starting with these exchanges. whether it's recapturing wasteful stimulus program dollars, eliminating fraud, or using the appropriation process to set budgetary priorities rather than mandatory spending, we must all exercise fiscal restraint and that's what this bill does. just because we follow greece in democratcy, does not mean we should follow them into bankruptcy. the chair: the gentleman's time has expired. the gentleman from new jersey.

mr. pallone: i yield now to the gentleman from new york, 1 1/2 minutes, to mr. engel. the chair: the gentleman from new york. mr. engel: i thank my friend for yielding to me. i rise in strong opposition to this bill. as ronald reagan used to say, there you go again. and then my republican colleagues go again. we sat through days and days of this in the health subcommittee and the energy and commerce full committee. this is, i don't know, the third or fourth or fifth or sixth bill on the floor trying to destroy the health care bill. i proudly support the health care bill and i think it's time to stop scaring the american people. this is political theater. the senate's not going to pass this. the president certainly would veto it if it passes. all we are having is once again another debate about health care on the house floor again and

again and again. i think my friends on the other side of the aisle have made their point, they oppose health care reform. fine. how many times do we have to vote on it? this bill, the affordable health care act, this would repeal it, puts the american people back in charge of their health care by requiring insurance companies to be more transparent and accountable for their actions. thus it ends many of the worst abuses by the industry and improves the quality of care. i urge my colleagues to vote against this bill. the chair: the gentleman's time has expired. the gentleman from texas. mr. burgess: thank you, mr. chairman. we yield two minutes to the gentlelady from tennessee, mrs. blackburn. the chair: the gentlelady from tennessee. mrs. blackburn: thank you, mr. chairman. i rise in support of the bill because this is the right step, it's a right time. and if you're listening to the american people, one of the things they have said loud and clear is, they do not want the obamacare bill on the flooks. they want this repealed.

when my colleagues say how many times do we have to revisit this issue? mr. chairman, we are going to keep revisitting this issue until we get every single piece of this bill off the books. because it is too expensive to afford. now a great example of this is exactly what we are dealing with . a little slice of it that gives as much as may be needed, as much may be consumed, as much as the h.h.s. secretary says they will need for this unlimited slush fund to give money to the states for these grants. now, i will remind my colleagues from across the aisle, our former democrat governor has called this program the mother of all unfunded mandates. mr. chairman, there is a reason that he called this program such. because he knows that putting this burden on to the states is far too expensive for the states

to afford. now, it doesn't make it right to set up a slush fund which will have no congressional oversight. the h.h.s. secretary can spend as much as they think is necessary, and they do not have to come back to us in congress for this. we do not need legislation with this nebulous language. we do not need to give that authority of spippeding taxpayer mon -- of spending taxpayer money on this to the h.h.s. secretary. and it is important that we distinguish. are we for reforming health care? there are portions of health care that need to be reformed. but what happened in obamacare? it's not health care reform. it is a movement away from patient centered health care to government control. it is time for us to get back on the right track. i yield back. the chair: the gentlelady yields back. the gentleman from new jersey.

mr. pallone: mr. chairman, i just yield myself 15 seconds. the gentlewoman i hold in a lot of respect, but it bothers me that you say we are going to come back and keep voting and voting again on repeal, repeal, repeal. we know this isn't going to pass the senate. when i went home the last two weeks all i heard was, what are you doing to create jobs? deal with the economy. when we deal with this and keep doing the same thing over and over again we don't deal with jobs. i yield now to the gentlewoman from california, mrs. capps, 1 1/2 minutes. the chair: the gentlelady from california. mrs. capps: i thank my colleague for yielding. mr. speaker, i rise in the strongest opposition to this shortsighted legislation. we all know that the only reason this bill is before us today is to try to derail the affordable care act, which is already helping so many. and the exchanges this bill targets will make it clear -- a clear impact making it easier for individuals and small

businesses to shop for insurance based on quality and price. they will provide the key structure to ensure the new protections in the law are followed and make the health insurance market both more competitive and transparent. furthermore, the exchange program gives states flexibility to build the best plan they can to meet the unique needs of their residents. but this bill would defund that, resulting in an unfunded mandate. 49 states have already received funds to begin this process. many states are poised to move from planning to implementation. however, repeal without this development -- would stop development in this tracks. a vote for this bill does not reduce costs, it just shifts them on to the backs of already cash strapped states. it means delays, delays that c.b.o. has noted will lead to increased costs for consumers. delays that will result in two million more americans being uninsured through 2015 alone. i find it ironic that my republican colleagues who for so long have called for increasing

a state's autonomy are here to vote down a program that does exactly that. especially when their vote will lead to increased costs and more americans being uninsured. i urge my colleagues on both sides of the aisle to vote against h.r. 1213. i yield back the balance of my time. the chair: the gentlelady yields back. the gentleman from texas. mr. burgess: thank you, mr. chairman. at this time i'd like to yield two minutes to a valuable member of the committee, mr. pompeo, of kansas. the chair: the gentleman is recognized for two minutes. mr. pompeo: request permission to revise and extend. the chair: without objection. mr. pompeo: thank you, mr. chairman. i rise today in strong support of h.r. 1213. a repeal of the mandatory piece of spending inside obamacare that will do a great deal to not only destroy health care in america but destroy jobs in kansas and all across our country. i spent the last couple weeks back in the district, and i

heard the ranking member today say that he wants us to do the people's work. i will tell you every day i heard about people that were frightened by obamacare. i talked to business leaders that understood that the last thing they wanted to do was to hire a full-time employee because of the burdens and obligation that is would come from this piece of legislation. i was proud at the very beginning of my time in congress to vote to repeal the entire bill and i'm equally proud today to attempt to put back in the box this mandatory spending provision. this spending provision gives without any oversight, any restraints the secretary of health and human services powers that are very, very large. i happen to have a special perspective on that. today secretary of h.h.s. was my governor for the last eight years. the last thing that we want to do in health care is to give my former governor an unlimited checkbook. we have seen what that has done to kansas. i know what that will do to the united states of america. look, this is very clear. when we talk about health care

what we are talking about is trying to find a way to reduce costs. the absolute worst thing you can do if you are trying to reduce costs is give the government an unlimited checkbook. they will spend it. they will spend it every day. they will spend it all the time. so i urge the strongest support of 1213 so that we can stop this horrible piece of mandatory spending. i yield back the balance of my time. the chair: the gentleman from new jersey. mr. pallone: thank you, mr. chairman. i yield a minute and a half to the gentlewoman from wisconsin, ms. baldwin. the chair: the gentlelady from wisconsin. ms. baldwin: thank you. i thank the gentleman. mr. chairman, i rise in opposition to this republican proposal because it will not create jobs. it will not stimulate our struggling economy. and it will not put the middle class back to work. instead, the bill that we are considering today would take away funding for states to offer new affordable insurance options for their citizens. and this bill would lead to job loss. hindering our fragile economic

recovery. bait and switch, that's what it's called when you say one thing and do another. when you run for office promising to create jobs and bolster the economy, and get elected and start doing something entirely different. last election was about jobs and the economy. and congress should be at the forefront. but instead of leading and putting americans back to work, we are considering a bill to repeal funding that will create jobs and provide families and small businesses with access to affordable health care options. . 48 state, including my home state of wisconsin, have received up to $1 million to get to health care exchanges up and running, including hiring key staff for implementation. in other words, this funding is creating jobs. this republican bill raises a very important question. are we going to ask cash-strapped states to return

the money they've already been awarded? are we going to prevent these states from receiving further funding that will create jobs? i fail to see how rescinding these dollars that will be used to create jobs is the right thing to do to get our economy back on track, and i urge my colleagues to stand up for americans looking for work and looking for affordable health care and vote against this bill. thank you, mr. chairman, and i yield back. the chair: the gentleman from texas. mr. burgess: thank you, mr. chairman. this bill only rescinds money that has not been obligated. i yield two minutes to the gentleman from iowa, steve king. the chair: the gentleman from iowa. kingofthebluegrass i thank you, mr. -- mr. king: i thank you, mr. chairman. i thank the gentleman for yielding. his voice is essential to this and putting this unconstitutional bill behind us

one day and taking us down the path to liberty and freedom with a constitutional path. i rise in strong support for h.r. 1213, mr. chairman. much has been made of $5.5 billion in automatic spending that was written into obamacare. that was a number that was kind of like a mirage, hard to pin down. in working with c.r.s. we finally got that number, $105.5 billion in automatic spending written in a bill that i don't think any member of congress was aware of that figure when obamacare was passed a little over a year ago, about 13 months ago. however, this bill, h.r. 1213, doesn't address that $105.5 billion in automatic, irresponsible, unconstitutional spending. it addresses an open slot where the drafters of obamacare just simply overlooked writing in a figure in when they brandted this unlimited authority to the

secretary of health and human services, kathleen sebelius, to spend the amount of money she sees fit, to carry out the provisions of this section that's repealed by h.r. 1213. it wasn't just a blank check, mr. chairman. it is a series of blank checks, in fact, an infinite number of blank checks that a number can be written into. that's how bad this is. that's how unquantifiable it is. i know that c.b.o. has attempted to put a number on it but it requires some assumptions even to do that. the 112th congress has been bound by the 111th congress. i don't see mandatory spending in this congress. no previous congress can bind a subsequent congress. this congress has to approve all spending of every federal dollar before it can be expended and we need to stand on that principle. and, mr. chairman -- mr. burgess: additional 30

seconds. mr. king: this mandatory spending is unconstitutional. i'd make the point, also, that the funding that would go to set up the state exchanges, we need to be very well aware of what that can be. if the states take this free money, so to speak, from this unlimited slush fund of kathleen sebelius, and set up the state exchanges, even though they believe they have control of these exchanges, it sets them up to be nationalized by a far more powerful federal government. even though they oppose obamacare, they might be complicit in its implementation if they accept this money. i urge adoption of h.r. 1213. i thank the gentleman from texas, and i yield back the balance of my time. the chair: the gentleman from new jersey. mr. pallone: mr. chairman, i yield myself 30 seconds. i just like to point out to the gentleman, 49 states and the district of columbia, along with four territories, have been awarded $45 -- $54 million in grants. these exchanges are still going to exist even if this bill passes and becomes law. all you're doing is taking away

the money in almost every case from your own state to try to set up these exchanges and not have it become a national exchange. the gentleman can talk all he wants about the funding but the fact of the matter is it's most likely that his own state is asking for this funding so they can get these exchanges established. why do the republicans want to take the money away from their own states? i yield now a minute and a half to the gentlewoman from the virgin islands, mrs. christensen. the chair: the gentlelady from the virgin islands. kristen dupard thank you. i speak out -- mrs. christensen: thank you, mr. speaker. i speak out against a repeal that will not help health care for the 30 million uninsured americans. as my colleagues said, almost $54 million in planning grants have been awarded to help the states, the dick, including $4 million for the virgin islands to create solutions to improve our states and territories'

health insurance markets. we must not repeal this funding as h.r. 1213 would do because by placing the burden entirely on the already overburdened states it will make it more difficult for them to establish exchanges and it will increase the cost of families who are seeking to insure themselves. this is another effort to get rid of exchanges altogether. i ask my colleagues to think about all of their constituents who suffer unduly from health conditions that could be prevented or controlled if only they had access to health insurance, preventive care and treatment. these constituents our fellow americans demand we step up and fight for their affordable health insurance, as democrats have always done and are doing today. i urge all my colleagues to vote against this legislation, that would undermine the ability of millions of americans to have access to health insurance and access to needed health care services. i yield back my time. the chair: the gentleman from texas. mr. burgess: thank you, mr. chairman. i'd like to yield myself one minute. how many times did we hear over

the runup of the passage of the affordable health care act, it can be nothing but far from the fact. the truth is they don't want you to keep your current insurance. we heard from members on the other side of the aisle that two million fewer people will be enrolled in the exchange and that the bill will increase cost to the employers. so here's some shocking news. these assertions that during the health care debate, under the bill you'll not be able to keep your health insurance you like in spite of promises made by the democrats. people were concerned that the new law would encourage employers to drop health care coverage for workers. in fact, we received some memos to that effect as part of an investigation that then chairman waxman actually initiated right after the passage of the bill. but then when trying to pass the bill, democrats repeatedly denied those claims. now, they seem to relish the fact that employers will drop coverage and they actually see it as a negative, that one million people will continue to

have employer-sponsored insurance, the coverage that they precisely wanted to keep. i yield -- i reserve the balance of my time. the chair: the gentleman reserves. the gentleman from new jersey. mr. pallone: mr. chairman, can i inquire how much time remains on both sides? the chair: sure. the gentleman from new jersey has 17 3/4 minutes. the gentleman from texas has 15. mr. pallone: ok. i yield now two minutes to the gentleman from texas, mr. green. the chair: the gentleman from texas. mr. green: thank you, mr. speaker. i thank my colleague on the energy and commerce committee for yielding to me. to follow-up what my colleague also from texas on energy and commerce talked about employers dropping insurance, that's why we need these insurance exchanges. even before the affordable care act, employers were dropping insurance for their employees. or making it cost prohibited for them to cover themselves. so that's why we need the exchanges. in here they're defunding it today in h.r. 1213. would repeal the section of affordable care act that provides funding for the creation and facilitation of

state-based health insurance exchanges. these are not government funded exchanges. those are private sector exchanges. the republicans spent most of their time to limit the abilities to taylor their own health care systems. -- tailor their own health care systems. it would create their own health insurance exchanges, meet the health care needs of their states and still provide consistent, basic health coverage throughout the country. we've come up with proposals on how they'll run their health insurance exchanges so states will run their own exchanges rather than the federal government doing it. here we are today stripping the ability of the states to run their own health insurance exchanges by eliminating those planning grants. just another example of the hypocrisy of the republican party. this is another political messaging in an attempt to defund health reform. they're playing games with funds, forcing states to spend their own money when states' funds are already limited. they have the wrong priorities and i think the american people

know it. i thank you, mr. speaker. i yield back the balance of my time. the chair: the gentleman from texas. mr. burgess: mr. chairman, i yield myself three minutes. mr. chairman, states are coming to the realization that there is no flexibility in these grants. they're coming to understand that the mere words that states -- that a state gets to develop an exchange that fits their individual needs, in fact, just wrings hollow. the other side has used the word flexibility as a big, big switch, as just -- just similar to the words, if you like what you have you can keep it. the authors of the bill praised these words but it's clearly not true. it puts washington in control, in firm control, in absolute control of these exchanges. for example, section 1302, the secretary will choose the essential benefits that must be paid for by individuals and families. in the state exchange. section 1302-d-2, the secretary will control whether an h.s.a. can be offered. section 1311-h, the secretary can by regulation select the

doctors and other health professionals that are allowed to provide care in the exchange plans. as a physician, i find this one of the more chilling provisions in this legislation. section 13 is 1-i, the secretary, the secretary decides whether a plan provides linguistically, appropriate and culturally sensitive appropriation. if they do not meet the secretary's approval they cannot have that plan. section 1311-c-1 and section 1311-e, the secretary, the secretary determines the process and requirements for certifying whether a plan can be sold in the exchange. section 1311-c-1-i-6, the secretary can decide what individuals can enroll in the exchange plan. section 1311-d-4, the secretary will judge the adequacy of an exchange internet website. section 1311-k, the secretary will determine whether an exchange established rules

which conflict or prevent the application of regulations promulgated by the secretary. in other words, not only do they get to make the rules, they get to be the referee. concerns were raised prior to the passage of the patient protection affordable care act that the law was designed, designed for employers to drop coverage so washington would control health care through obamacare exchanges. now, the other side protests one million people will keep their employee-sponsored insurance because they would rather have them under the direct and absolute control of washington, d.c., rather than their state capitals. i'll reserve the balance of my time. the chair: the gentleman reserves. the gentleman from new jersey. mr. pallone: mr. chairman, i yield myself 30 seconds. again, i don't understand what dr. burgess is trying to -- the point he's trying to make. if we don't have this funding under this bill, states are not going to be able to choose the type of marketplace that's best for their families and businesses. by passing this bill, you take away ultimately the states'

rights to make a decision what kind of plans they have and how they want to tailor these plans. all he's doing with this bill is handing it over fought government, exactly opposite of what he's saying. what he's reading is what will happen if there is no exchange, if there's a federal exchange. so why deny the states money when they can tailor the exchange with those grants? i yield now to the gentlewoman from connecticut, two minutes, the gentlewoman from is the ranking member on the labor- h-appropriations subcommittee. the chair: the gentlewoman from connecticut. ms. delauro: i rise in opposition to attempt to defund one of the cost cutting reforms of the affordable care act. this bill takes money out of families' pockets and gives it to the health insurance industry. the exchanges will give all americans a chance to prosper

from what members of congress and large employers have enjoyed for years, large group rates, lower administrative costs, greater transparency. they also expand choices, giving everyone access to a much fuller range of plans. the exchanges work to create real competition in the health industry and thus drive costs down for everyone. but my colleague on the other side of the aisle -- colleagues on the other side of the aisle want to control the -- they want to turn medicare, ending medicare and throwing seniors to the private insurance market. this is in the same ain. it limits the free market reform, allow insurance to act as monopolies, according to the

c.b.o., the congressional budget office, which is nonpartisan, it will knock two million people out of the exchange, increase health insurance premiums and leave 50,000 more americans uninsured. in fact, 85% of the so-called saves here comes from cutting off americans' access to health insurance. this is not the direction we want to go. we want to cover more people, reduce health care costs. this bill raises premiums, it raises the number of uninsured in america and i urge my colleagues to reject it and a final point. you know, we in this body are very fortunate. we have health insurance. our kids have health insurance. and when we get ill we go to the head of the line, same as our family. every single time we take to this floor, the majority in this body wants to repeal health care reform, want to take away the opportunity for millions of americans to have the same kind of health care coverage that members of congress and their families

have. i yield back. the speaker pro tempore: the gentleman from texas. mr. burgess: i yield myself one minute, mr. chairman. i remind my colleagues on the other side of the aisle that the governor of utah coming to our committee hearing said that he was setting up exchanges prior to the passage of the patient protection affordable care act. the passage of the patient protection affordable care act has limited his ability to provide those exchanges. in fact, he went so far to say now with the nebulous future surrounding the patient protection affordable care act because of activity in the courts, not in the united states house of representatives, but in the courts, remember them? the third branch of government that gets to decide if something is constitutional or not? because of the ambiguity surrounding the cases in the courts, the governor of utah felt he could not go forward with the plan he was implementing and he worried the money he already spent, his own

state's money, would now be for naught. he doesn't know

interpreted. so in a very perverse way we have made it harder for a state to provide exchanges by passing the patient protection affordable care act. i reserve the balance of my time. the chair: the gentleman reserves the balance of his time. the gentleman from new jersey. mr. pallone: mr. chairman, i yield myself -- a minute. i have heard dr. burgess talk about governors. i just want to give you some quotes from some governors. republican governors. nathan deal, former energy of commrg anders in committee. former chairman of the health subcommittee. this is what he said with regard to the state exchanges and the grants. he says one of the real problems is some of us as governors foresee is if the mandates on states remain in place, but the funding from the federal level to carry out those mandates is withheld, that's the worst possible condition that states could be left in. that is what my colleague from texas is proposing. how the states will continue to have the mandate to set up the exchange or without money and therefore not be able to taylor the exchange -- tailor the exchange to the state or letting it go to the federal government, having the federal government run the exchange. nathan deal, one of our own members, chairman of the subcommittee said, worst possible scenario, i don't understand, i keep saying the same thing but i have to repeat it, mr. chairman, to say that we are going to have state exchanges without having the funding means that the state exchange will either be lousy or it simply won't exist and the federal government takes over. i yield two minutes to the gentleman from michigan, mr. levin, the ranking member on the ways and means committee. the chair: without objection. mr. levin: thank you, mr.

pallone. thank you for your efforts. i have been listening to the debate here and the majority i would describe it this way that you really have become mindness. you come here and talk about federal control what this bill would be to increase it. c.b.o. says pass this bill and you will have more federal control not less. and less state control. it makes no sense. it's mindless. and you come here and say there's one governor who says something about his exchange but every state but one has applied for and received a grant for their exchange. it's mindless your position.

my state has already received it, the grant, the state of michigan. used it to bring everybody to the table. including private industry. including consumers. hospitals. etc. to develop a plan that's right for our state. it's mindless for you to come here and say you want to -- pass a bill that withdraws from our states the ability to plan for the health care for our citizens in a way that is helpful to our state. maybe there will be a mindless yes vote here. it's happened before. where are the jobs bills? i field back. the chair: the gentleman from texas.

mr. burgess: thank you, mr. chairman. i would not presume to put words into the mouths of the governor of georgia, but i do know from a long association with him that he was very abhorrent of any mandates placed on the states. i do not doubt the fact that he said the worst of all possible worlds would be to get the mandate and not get anything else to help him enact that mandate. but to be very clear, the mandates them selves are the anathema. why would those mandates be a problem for the governor of georgia or any other state?

these exchanges, yet health and human services democratic, the secretary, will choose the essential benefits that must be paid for by individuals and their families. that's no longer a state decision, that's no longer a gubernatorial directive, that is now a directive from the secretary of health and human services. they would also decide whether their network is adequate regardless of whether or not it covers a doctor you use or like. the secretary, not the governor, not the governor's chief of staff. not someone in the state legislature, the secretary of the department of health and human services who has that now unprecedented power and is only limited by her own imagination. the secretary would impose price controls on health coverage. the secretary would pick who gets a waiver from the annual limit requirements. the secretary would establish cost shared requirements regardless of their effect on premiums. not a gubernatorial directive, not something established by the state commissioner of insurance, not something contributed to by the governor's chief of staff. not something decided by any state legislature, but by the secretary of the department of health and human services. again, chairman upton in his opening remarks said, this -- the spending would only be limited by the imagination,

limits of the imagination of the secretary of the department of health and human services. we know who that is this year. we don't know who that is next year. we certainly do not know who that is in two year's time. it is the responsibility of this congress to exercise the due oversight over these programs. we abdicated that authority by the forward funding of these programs, as mr. king pointed out in his remarks, we abdicated that authority. it's time for congress to claim that back. that's not mindless. the mindlessness, i might remind the speaker, the mindlessness was when this bill was passed a year ago without due proper authorization and oversight. i reserve the balance of my time. the chair: the gentleman reserves. the gentleman from new jersey. mr. pallone: mr. chairman, i yield myself one minute. again, i listened to the gentlewoman from tennessee, mrs. blackburn, before, and basically she said, we are just going to repealing and repealing and repealing. i understand that you want to get rid of the whole bill. but why do you bring up

legislation today that, again, i guess you're doing it because you don't want to keep repealing the whole bill over and over again because it becomes ludicrous. instead you take pieces out n. this case the state exchanges, and not give states the grants to follow up. it's obvious when we talked about nathan deal, he doesn't like the law. heed like to see it repealed, but he's saying if you're not going to repeal it, don't defund it because then the states can't carry out their functions in an effective way. all i'm saying to my colleague from texas is, if you just want to keep repealing and repealing like mrs. blackburn said, go ahead and do t we'll waste time which doesn't make sense. but if you're going to take pieces out, then don't say to the states we are going to defund you and not allow you to do what you are already required to do or send this over to the federal government. this is the absurdity of what the other side of the aisle is trying to do. it's just a complete waste of time. i yield now two minutes to the

gentleman from california, mr. miller. the chair: the gentleman from california. mr. miller: i thank the gentleman for yielding. what is it about the republican party that insists that its mandate in washington, d.c., is to keep the american public away from affordable health care? first they start by ending medicare so that senior citizens who retire will have to pay much more for their health care than they would otherwise. those on medicare because they'll be closed in, an aging population, their health care costs will continue to go up -- -- they have decided they are going to decrease the access of young people to they decided to roll back pre-existing conditions. that prevent women from getting

coverage of health care, young children from getting coverage of health care from life threatening diseases that they were born with. what is it about the republican party that they don't want people to have access to health care in this country that's affordable? if they can find it and afford it and have it. now we come to a time when they said they don't want one-size-fits all in washington. the states should have the right to set up the exchanges. the states should have an option and set up an exchange or not. some 49 states have stepped forward and said we want a right to customize the exchange for the purposes of the people we represent. the nature of our state. the economy of our state, age of our state. we want to do this. now they are saying, that's good. but we are not going to give you any money to plan to do that. so what are they doing? according to c.b.o., they are now threatening, once again, the access to affordable health care

for 50,000 or more americans. they threaten the access to health care for women, children, for seniors? they threaten -- for those about to become seniors? they can't stop doing this. just 30 seconds. they want to say they are just repealing the health care bill that was passed. they are just repealing that. what they are doing is they are standing in the way, the very same rights they have as members of congress, to have a federally set up exchange, for federal employees, where policy pass muster to get real value if you buy one whether you buy a health savings account or plan for your family or individual. you get real value. you get access. the rights they have as members of congress once again they are stepping into the breach to make sure that their constituents won't have that right at the state level because when there are no state exchanges, they

won't have that right. it's a really strange view of their obligations to the american public to working families, to children, and to seniors. it's a real strange view about their position of privilege that they would have all of this for themselves but not for their constituents. the chair: the gentleman's time has expired. the chair would ask all members to he'd the gavel. -- heed the gavel. the gentleman from texas. mr. burgess: i missed that last directive from the chair. the chair: i said the chair would ask all members to heed the gavel and then the chair recognizes the gentleman from texas. mr. burgess: you're very kind, mr. chairman. i will direct my remarks to the chair. not to anyone in particular. as i believe is one of the rules of the house. i yield myself one minute for this purpose. i was always taught growing up if you're going to tell a story you ought to begin it with once upon a time. i think i should have heard a few once upon a times in that last tirade just leveled upon the house. the other hypocrisy knows no bounds.

the other side claims the health care law is about state flexibility but they oppose h.r. 1213 because some states may need -- if you're for flexibility and then eliminating complete control the secretary has over the state exchanges let states establish exchanges without costly federal mandates and finance them how each state feels is appropriate. now, to talk about hypocrisy, what the other side fails to mention that under the patient protection and affordable care act, advocates taxing health care plans that sell insurance and advocates taxing health care plans that sell insurance in the exchanges rather than being solid on how states should fund their exchanges once the grant money runs out, the democrat health care bill actually spells out that the states should consider charging taxes on health insurance premiums for plans sold in the exchange. i yield myself an additional 0 seconds. the hypocrisy could be tolerable if it just simply ended there.

however the other side also fails to mention that the patient protection affordable care act directly charges a $60 billion tax on american's health insurance premiums in section 9010 or that imposes tens of billions of dollars in direct taxes on medical devices and drugs that people will use to -- that will increase their health care premiums. according to the c.m.s. actuary. i reserve the balance of my time. . the chair: the gentleman from new jersey. mr. pallone: mr. chairman, can i inquire of the time on both sides? the chair: the gentleman from new jersey has 7 1/4 minutes and the gentleman from texas has 7 1/2. mr. pallone: i now yield three minutes to the gentleman from california, mr. garamendi. the chair: the gentleman from california. mr. garamendi: thank you, mr. speaker, and thank you, my friend from new jersey. this is all about creating a mechanism for competition. fair, open, full disclosed

competition. the exchanges actually come from maybe 0 years ago. i know that in california when i was elected insurance commissioner in 1991, we established an exchange program , passed the legislature. unfortunately governor wilson vetoed that legislation. had it gone into place there would have been a marketplace for insurance consumers. right now consumers are at the whims of the market. they have no power. an exchange is simply a way to accumulate the purchasing power of thousands or hundreds of thousands of individuals and small businesses so their risk is spread out over that large population. right now small businesses and individuals simply are at the mercy of the insurance company. they have no way to spread their risk and, therefore, their rates are exceedingly high and in many cases

impossible to get insurance. for the life of me i do not understand why the republicans want to repeal the exchanges. i always hear from them competition and free market. this is exactly that. this is competition in which the insurance -- health insurance companies have to compete with a similar policy, four different kinds of policies, a very rich one and a very basic one, and they have to compete on quality. well, what's the problem with that? and they'll be able to get insurance. right now they can't. so they're going to repeal it. makes no sense. also makes no sense that the republicans would go out and terminate medicare. hello. you're going to terminate medicare, a guaranteed insurance policy for everyone over 65? oh, i know. only those who are below 55 years of age will never see medicare. it's gone. it's history. oh, you're going to give them a

voucher, a small percentage of the total cost 10 years out. good luck. and you throw them to the whims of the insurance companies without an exchange. what's this all about? i think congressman miller may have had it right. how do you view the world? people need health care. insurance is a way to get health care. exchange is a way to spread risk under -- for a large pool of people so the risk is there and access to the market. california has an exchange. california last year established a law to put in place an exchange. it was signed by a republican governor, folks. you listening? governor schwarzenegger signed the exchange program. it's going into operation in a year and a half so that people in california can get insurance. two million people will not be able to get insurance if this bill were to pass. and the only thing you offer is the termination of medicare? oh, and by the way, you reduce

medicaid by $700 billion. thank you, mr. speaker. i yield back my time. the chair: the gentleman from texas. mr. burgess: mr. chairman, i'll yield myself one minute. although the issue of medicare is not the subject of this debate today, i can recall a time about 20 years ago when paul tsongas, a former senator, came to dallas to talk to a group called the dallas business group on health. it was the day after president clinton had come to this house and addressed a joint session of the house and senate and unveiled his health care plan in september of 1993. senator tsongas came to talk to us in dallas. he said it was a beautiful speech, there wasn't a dry eye in the house. the only problem was that the president proposed five new entitlement programs and we cannot pay for the ones that we have. former senator tsongas then went on to articulate how the rate of rise of entitlement

spending was going to cripple this country in the future such that by at some point between 2015 and 2020 this country would see intergenerational conflict, the likes of which it had never seen before. yes, it is incumbent upon us to recognize the train wreck that's coming and deal with it. representative ryan put forward a very thoughtful plan two weeks ago. let's see the plan from the other side. so far that's been lacking. i'll reserve the balance of my time. the chair: the gentleman from new jersey. mr. pallone: mr. chairman, may i inquire -- i have no additional speakers. i don't know if the gentleman has the right to close, correct. how much time do i have? the chair: 6 1/2 over here. 4 1/4 over here. mr. pallone: do you have additional speakers? mr. burgess: well, as enjoyable this has been with me against the world, i'll accept the gentleman's offer to wrap the debate up. mr. pallone: all right. the chair: the gentleman from new jersey.

mr. pallone: i'll yield myself such time as remains, mr. chairman. mr. chairman, i'm pleased that my colleague on the other side, dr. burgess, got up and talked about the ryan budget, or the republican budget, i should say. as far as i know, every republican voted for it and most democrats voted against it. and he also mentioned i think president clinton's effort to achieve health care reform. you know, the democrats over the years, harry truman, president clinton, president obama have all been reaching out to try to achieve health care reform and find a low-cost way of providing a good benefit package to all americans. it's sad to think that on the other side of the aisle when they became the majority, the first thing they did was to pass this republican budget that actually puts an end to medicare and really jeopardizes the future of medicaid as well. i think it says a lot about the fact that the democrats are

trying to expand health care choices and options and provide low cost health care with good benefit package. the republicans are taking the plans that exist now like medicare and medicaid and neither ending them in the case of medicare or in the case of medicaid really making this so it's going to be very difficult for medicaid to continue. we already have in place, as i mentioned in the beginning of this debate, many of the positive aspects of the affordable care act, all those things that ealmost nate discrimination, let you put your children on your policy, start to plug up the doughnut hole for prescription drugs for seniors. this is working. this is legislation that's working and making the difference for the american people and making it possible now with the state exchanges once they're up and running with the tax credits that are available for even those other 32 million or 30 million to 40 million americans that don't have health insurance now to finally have it. now, why do the republicans want to eliminate this?

i listened to dr. burgess. he says it costs too much. well, the fact of the matter is the c.b.o. said the affordable care act was going to save money, reduce the deficit over 10 years. i know they only like to look at the c.b.o. numbers when they think they're beneficial to their point of view but the fact of the matter is the c.b.o. is a nonpartisan arm of this congress and they say that the affordable care act reduces the deficit over 10 years. at the same time we're covering everyone and we're providing a good benefit package, just like blue cross blue shields too. what this does is eliminate choices because if the states are allowed to tailor a program in exchange for their own constituents in their state i believe it will be more robust, it will be a better plan tailored to those people from new jersey, in my case, or texas, in the case of dr. burgess. by taking away the money through the exchanges, all you're going to do is make that more and more difficult. states will still have to do it

but they won't have a good plan. they may limit their choices. they may not have a lot of choices which they would have if they have some money to plan and be rational about how this works. and, of course, the more likely scenario is that we'll simply have a federal exchange and a lot of states will opt out and not even have their own state exchange. i think that would be a mistake to do. i really do. as much as, you know, i'd rather have a federal exchange than no exchange i do think it would make sense to have state exexchanges. again, what the republicans are doing now, and i think mrs. blackburn said it earlier, we'll repeal it until we get rid of the whole thing. well, don't waste the time of the congress on doing the same thing over and over again. i was told for the last two weeks, we all had a break, we were at home for two weeks, all i heard -- i didn't hear about health care. i heard about jobs and how the economy was starting to sputter

again. you know, the last quarter was not as good as it could have been and the fact of the matter is since the republicans have come into the majority here they're not doing anything to create jobs. we don't have a bill to create jobs. we're doing the same thing every day. today will be defund health care. tomorrow it's going to be abortion again. i don't know how many times we are going to have these same bills that will come out of the health subcommittee and the energy and commerce committee. it's unfortunate. i urge my colleagues to vote no on this bill. the chair: the gentleman's time has expired. the gentleman from texas, mr. burgess. mr. burgess: mr. chairman, at this point i'd like to yield four minutes to the chairman emeritus of the full committee, mr. barton from texas. the chair: the gentleman from texas. mr. barton: thank you. thank you, congressman burgess. it's good to see you in the there, mr. speaker. i feel empowered and confident that you're going to make the right rulings as the day goes on. i would ask to revise and extend my remarks. the chair: without objection.

mr. barton: thank you. we're going to have more amendments offered on this small part of the repeal effort of the new health care law than the democratic majority allowed in the last congress on all the health care legislation that they brought to the floor. after general debate we're going to have at least five amendments that were made in order under the rule. that's five more than speaker pelosi and then rules committee chairwoman slaughter made in order in the last congress when we were debating these issues. republicans are not necessarily opposed to the concept of these exchanges, mr. speaker. what we are opposed to is the process in the last congress where the actual bill that became law was dumped in the dead of night with no amendments made in order,

little debate and an up or down vote as soon as the speaker twisted enough arms on the then majority side of the democratic party to move the bill. so we're trying to repeal it piece by piece. once that's done, then to replace it. this particular bill that's before us is pretty straightforward. it repeals the authority of the secretary of health and human services to on i will combate such sums as necessary to fund these -- obligate such sums as necessary to fund these changes. these such sums as necessary could be $50 million. could be $100 million. could be $200 million. could be half a billion dollars. we just don't know. those of us on the now majority side, the republican side, think that's bad management.

such sums as necessary. so we're not really having a debate on whether exchange is good or bad. i can agree with my friend from new jersey that in concept exchanges are good. now, i could have a debate that if you're going to have exchanges you ought to let the market operate and determine what's offered in the exchanges and not mandate what has to be qualified in order to be a part of the exchange, and we could have a debate on what the premiums are and what the coverage is and whether you'll allow flexibility or whether you put these federal mandates on what has to be in the health care plan to be a part of the exchange. but that's a different debate. the debate today, mr. speaker, is, should the secretary of health and human services have the ability to obligate without any constraints by the congress such sums as necessary to

empower and fund these health exchanges? we say no. so we're going to urge a yes vote at the appropriate time so that we can take away that authority, send this bill to the other body and hopefully have that passed. and then at some point in the future bring back a reformed bill where we have the policy debate which, again, i think you can say that there will be some agreement between the majority and minority side on the underlying policy. but on the fact that the secretary of health and human services shouldn't be able just to obligate with no oversight by the congress how much money goes in the creation and maintenance of these exchanges, we think the answer to that is she should not -- the current secretary or any future secretary should not have that authority and that's why we put forth the bill. with that i'd yield back the balance -- or yield back to mr.

burgess, the balance of my time. the chair: the gentleman's time has expired. the gentleman from texas. mr. burgess: we'll yield back the balance of our time and urge an aye vote on the measure. the chair: the gentleman yields back. pursuant to the rule, the bill shall be considered read. no amendment is made in order except those printed in house report 112-70. each such amendment may be offered only in the order printed in the report by a member designated in the report, shall be considered as read, shall be debatable for the time specified in the report equally divided and controlled by the proponent and an opponent of the amendment, shall not be subject to amendment and shall not be subject to a demand for the division of the question. it is now in order to consider amendment number 1 printed in house report 112-70. for what purpose does the gentlewoman from texas rise? ms. jackson lee:: i have an amendment at the desk. the chair: the clerk will

designate the amendment. the clerk: amendment number 1 printed in house report 112-70 offered by ms. jackson lee of texas. the chair: pursuant to house resolution 236, the gentlewoman from texas, ms. jackson lee, and a member opposed, will each be recognized for five minutes and the chair recognizes the gentlewoman from texas. . ms. jackson lee: thank you, mr. chairman. listening to the general debate, i have to say that i am concerned and not supportive of this legislation and would hope we vote against the underlying bill. but i have an amendment that i believe my colleagues on both sides of the aisle would appreciate and it's very simple. this amendment will provide the public with important information about mandatory funding to the state for health benefit exchanges that will no longer be available for the public and small businesses to use in order to obtain competitive coverage and let the public judge for themselves. good health care or not.

this particular amendment deals directly with the concern that we don't have the ability to move forward on health exchanges that will help vast numbers of americans. for example, the health -- the american health benefit exchanges make it easier for small businesses and the public to obtain competitive health insurance on the basis of price quality rather than be subject to the abuse of insurance companies which would charge exorbitant rates. it's aimed at providing coverage to the uninsured. 6.2 million texans don't have health insurance. of the -- those uninsured texans, 18% are children. texas is home to nearly 400,000 small businesses employing less than 500 people, and nearly two

million self-employed entrepreneur, letting everyone know we're making a good dent in the deficit which we can do in many, many other ways will also show them why i don't have good health care. meaning why don't small businesses and farmer? at this time, i ask that my colleagues support an amendment that is transparent to let you know what the savings are, and the question, what's happening to the accelerating rate of health care and the sick people getting sicker. with that, i reserve my time. the speaker pro tempore: the gentlelady reserves. the gentleman from texas, for what purpose do you rise? mr. burgess: i rise in opposition to the amendment. the chair: the gentleman is recognized for five minutes. mr. burgess: i supported a seemingly similar amendment three weeks ago when we considered a bill related to the public health slush fund in the patient affordable care act however, i have to oppose this amendment because despite the

similarity of the two amendments this isn't an apples to oranges comparison. the slush fund proside -- provided a specified amount in mandatory funding for the secretary in fiscal year 2011 and each year thereafter. ms. jackson lee's amendment three weeks ago would be possible to determine the amount of funds rescinded in fiscal year 2011 if h.r. 12317 had been enacted into law. but the amendment offered today strengthens the arguments in favor of passing h.r. 1213, the bill before us today. section 1311 of the patient protection affordable care act provided the secretary with an unlimited amount of money with virtually limitless discretion to spend on establishing exchanges or what activities could facilitate enrollment in what are known as qualified

health plans. giving the secretary a blank check is an abdication of our responsibility here in the house of representatives. this blank check makes it impossible to implement the jackson lee amendment. there is no dollar figure for how much the secretary can spend on this program. it is an unknown. the secretary could decide tomorrow to spend another $100 million or another $100 billion. in 2013, the secretary could take the advice of c.m.s. and fund money into any amount of activities. congress and for that matter the general public won't know that until the money is spent. i think the gentlelady from texas has good intentions with her amendment. unfortunately, because congress decided to leave it entirely up to the secretary of health and human services and the secretary alone to determine the amounts of money that could be spent, the amendment does not work in this circumstance. i urge my colleagues to oppose

the amendment. the chair: the gentlelady from texas. ms. jackson lee: how much time is remaining? the chair: the gentlelady has three minutes. and the gentleman has three minutes as well. ms. jackson lee: it is not hard to indicate what money are you allegedly saving. since they have the savings on the back of medicare patients and sick families and sick children and to see how we can stop the normal primary medical care you would get for children that these health exchanges would provide and as well neo natal care for children born primaturely, this is what the republicans would like us to do as we eliminate health exchanges. he should look at what's already happened. 49 states including the state of dr. burgess and myself, the state of texas, has applied for

funding for health exchanges. so to stop in the middle and suggest ire impacting the deficit, no, you're indicating you want to close down the good health care we're trying to promote. insurance exchanges would be available again for small businesses. texas is home to nearly 400,000 of them. the kaiser foundation says 23% of the texas population lives in poverty. they would be able to participate in thesics changes. i make the argument that it's good to put how much money you're saving to see how much you're losing by all the sick people who won't have care. the chair: the gentlelady reserves. the gentleman from texas. mr. burgess: i would point out that the gentlelady's amendment under legislation considered previously was appropriate because there were funding levels mentioned in the legislation. now, reading from the patient protection and affordable care act here in section 4002 under the prevention and public

health fund, paragraph b, which discusses funding, there are hereby authorized to be appropriated and appropriated to the fund out of any moneys in the treasury not otherwise appropriationed, one, for fiscal year 2010, $500 million, two, for fiscal year 2011, $750 million. in other words the funding is explicit under the previously considered legislation. under the legislation today, which is the health benefits exchange, here is how the funding language reads. for each fiscal year, the secretary shall determine the total amount that the secretary will make available for each state for grants under this subsection. we have no earthly day, is that $10? $100? $100 million? $100 billion? $13 trillion? we have no earthly idea.

so while the intent of this amendment in previous legislation was one which the majority could accept, in this case, it actually becomes meaningless because there is no dollar figure specified as the upper level of what the secretary can spend. i reserve the balance of my time. the chair: the gentlelady from texas. ms. jackson lee: i thank the gentleman, he's made my argument. the secretary of health and human services can state the funding that might be used. in addition, isn't it interesting that it's being repealed on the basis of savings yet the republicans can't explain if there will be savings or not. at the same time, sick people will get sicker and in my state, 44 out of 100 people have cancer, 32% are diabetic, and they need coverage. show us what you're going to save. put it on the website. let the american people see it

and explain why you would rather put thees dollars on, why you raise the cost in an unbelievable way for the fact that people will not have insurance and they'll get sicker and sicker and sicker and sicker and god forbid if we take out medicare and all the seniors will wind up being sick and lose their lives as well. i reserve. the chair: the gentleman from texas. mr. burgess: i reserve. the chair: the gentlelady from texas. ms. jackson lee: i thank the gentleman for much. if h.r. 1213 passes, it will severely harm cash-strapped states that cannot afford to establish health exchanges, and people of all backgrounds, the small businesses, farmers, and the children you've seen on these posters. i ask my colleagues to support this important amendment. show your card. if we're spending money, let it be on the website and let us compare, those savings against the thousands and millions of individuals who will be blocked from having health exchange

opportunity while some of us have savings accounts, others will have nothing, absolutely zero. vote for the jackson lee amendment to show the cards of what happens when you cut out and repeal health care coverage for american. i reserve. the chair: the gentlelady's time has expired. the gentleman from texas has a minute and a half. the chair: the travesty here is that there is no upper limit on what the secretary of human service can spend on these health exchanges. it is pointless to put up how much is saved when the amount that could be saved is -- that could be spend is to infinity. the spending has to stop. that's what this legislation is about today. that's why i urge my colleagues to vote against the jackson lee amendment and vote for the underlying bill. i yield back the balance of our time. the chair: all time for debate has expired. the question is on the amendment offered by the

gentlelady from texas. those in favor say aye. those opposed, no. in the opinion of the chair, the noes have it. ms. jackson lee: i'd like the yeas and nays. the chair: does the gentlelady ask for a recorded vote? ms. jackson lee: i ask for a recorded vote. the chair: under clause 6 of rule 18, further proceedings on the amendment offered by the gentlelady from texas will be postponed. it is now in order to consider amendment 2 printed in house report 112-70, for what purpose does the gentlelady rise? ms. waters: i have an amendment at the desk. the chair: the clerk will report the cleament. the clerk: amendment number 2 printed in house report 112-70, offered by ms. waters of california. the chair: the gentlelady from california and a member opposed will each control five minutes. the chair recognizes the gentlelady from california. ms. waters: my amendment requires the secretary of health and human services to submit to congress a report on the extent to which states are

expected to have difficulties establishing health benefit exchanges without the federal assistance repealed by this bill. the aed forable care act requires the establishment of health benefit exchanges in every state. these exchanges will be a marketplace where individuals, families and small businesses can purchase health insurance. the exchanges feature the the health plans offered by different insurance companies, all of which must offer a comprehensive set of essential health benefits at affordable prices. the purpose of these exchanges is to enable american consumers to compare premiums, out of pocket expenses, and benefits and make informed choices among competing health plans. the affordable care act places an emphasis on state-based health reform. the affordable care act allows states to set up their own health benefit exchanges aened offers grants to states to

assist them in doing so. a toal of 49 state the district of columbia and four territories have already applied for these exchange grants. these states are territories are working hard to determine what type of health insurance marketplace will be best for their families and businesses. some states can have difficulty exchanging exchanges in a timely manner. this can lead to poor management of exchanges, fewer health plans included, delay, and getting the exchanges up in money. some states may refuse to establish exchanges at all in the absence of federal assistance. this would result in greater cost for the federal government because the affordable care act requires the federal government to set up health exchanges in those states that do not set up their own exchanges. according to the congressional budget office, states that attempt to set up health

exchanges without federal funding may face challenges in making their exchanges fully operational by 2014 as the law requires. these challenges can limit the desirability of exchanges for consumers and reduce the capacity of some exchanges to process enrollment. as a result, c.b.o. estimates that by 2015, there will be almost two million fewer people enrolled in state exchanges. many states are already facing a decline in revenues and budget pressures as a result of the recession. some states have force -- were forced to make painful choices, increasing taxes or cutting spending in order to make ends meet. budget pressures have forced states to consider closing public health facilities and infrastructure projects and laying off teachers, law enforcement officers and other public employees. if the federal government

expects states to set up health exchanges without any assistance it will only compound their budgetary problems. my amendment requires the secretary of health and human services to report to congress within six months an enactment on the difficulties states will encounter while trying to set up these exchanges. if congress is going to deny states the funding that was there for them to set up health exchanges, congress needs to know the extent of the difficulties states will face without these funds. i urge my colleagues to support this amendment and i yield the balance of my time. . the chair: the gentlelady yields her time. the gentleman from texas. mr. burgess: i rise in opposition to the waters amendment. the chair: the gentleman is recognized for five minutes. mr. burgess: and i stand in opposition to the waters' amendment because it does perpetuate the fall is i that the patient protection and affordable care act will actually provide affordable health care coverage options.

you know, we've had this debate for sometime and my colleagues on the other side of the aisle have argued that the way to provide affordable -- an affordable coverage option to the uninsured is through a massive 2,700-page law authorizing thousands of new pages of regulations. yet, we've learned that nearly one costly requirement of the many contained in the patient protection and affordable care act has forced the secretary to issue over 1,200 waivers. now, mr. chairman, i want you to take a minute with me and to envision in your mind's eye, i want you to visualize a central planner, maybe a benevolent planner, moving data points around on a spreadsheet. that's what we're going to have under this. washington will literally impose thousands of new requirements on plans that kindly bureaucrats are kind enough to allow poor americans

to buy in the patient protection and affordable care act's exchanges. the only way to make these federally controlled health plans affordable is through massive subsidy contained in the patient protection and affordable care act. yet, every member of this body should know that we can no longer afford the business as usual spending bin g to which my -- binge to which my democrat friends are clearly affixed. i reject the premise of this amendment. remember a few moments ago when debating the baseline bill, we gave the secretary of health and human services the ability to write all the rules of the game an then to function as the referee to interpret the rules. and that's what we're furthering with this amendment. the underlying assumption of this amendment is that the secretary of health and human services should issue a report to judge the benefits of the regulations. oh, by the way, regulations that her own department writes. given the politically charged reports being issued by the

department of health and human services since the passage of the patient protection and affordable care act we shouldn't pay for another taxpayer financeded a -- financed bill. i urge a rejection of the waters amendment. i reserve the balance of my time. the chair: the gentleman can't reserve. the gentlelady's time has expired. you have to yield back or keep talking. mr. burgess: i yield back the balance of my time. the chair: the question is on the amendment offered by the gentlewoman from california. those in favor say aye. those opposed, no. in the opinion of the chair, the noes have it. ms. waters: i request a recorded vote. the chair: the amendment is not agreed to. prix de karakorum, further proceedings on the amendment offered by the gentlewoman from california will be postponed. it is now in order to consider amendment number -- i've given you one. it is now in order to consider amendment number 3 printed in

house report 112-70. for what purpose does the gentleman from minnesota rise? mr. ellison: amendment at the desk. the chair: clerk. -- clerk. -- the clerk will designate the amendment. the clerk: amendment number 3 printed in house report 112-70 offered by mr. ellison of minnesota. the chair: pursuant to house resolution 236, the gentleman from minnesota, mr. ellison, and a member opposed, will each have five minutes. the chair recognizes the gentleman from minnesota. mr. ellison: my amendment would require the secretary of health and human services to submit to congress a report on the impact of h.r. 1213 on the possible delays and potential enrollment

deductions to health benefit exchanges. republicans controlled both the house, the senate and the white house and they controlled all three of those institutions at a time when americans were literally going bankrupt because of medical debt. because of medical debt, and the fact that the republicans refused to do anything at all to try to help americans from our health care system which was dysfunctional and broken, they did nothing. they stood back and watched 60% of all bankruptcy filings be as a result of medical debt. they sat back and watched 47 million americans be uninsured as they faced nothing more than the emergency room. they sat back and watch small businesses either have to offer no health care insurance at all or have to stomach an enormous health care burden where premiums just gallupped along day after day. they -- galloped along day

after day. they sat back and watched where $2,500 of a car was nothing but insurance costs. this is the republican caucus that now seeks to take away what the democratic caucus and the united states congress passed last time. instead of trying to say we're here to do something, we're here to offer some solutions, all we want to do is strip away from americans that little bit of protection from the health insurance industry that they've been subject to for many years. instead of saying we're here to help, they're here to help the insurance companies, that's whose side they are on, mr. chairman. it's a shame and a disgrace and i'm sad to see this bill on the floor at all. so what i'd like to do is offer an amendment, mr. chairman. i'd like to offer an amendment to say if we are going to take away from the american people these exchanges that are going to give them a little bit of relief, a little bit of relief, let's at least know what we'ring do.

let's at least figure out what the effects will be on the american people instead of just snatching out of their hand these exchanges that are designed to give them a little bit of relief from the health care insurance companies. let's find out who is going to be delayed, what potential enrollment reductions are going to happen. i think it's an important and meritorious amendment. i think at least the republican caucus can do, the least they can do is say, you know what, if we are going to create -- go back to the bad old days back -- before health insurance reform, back before the affordable care act was passed, before we go back to the bad old days, we should know what harm we're doing to the american people. i urge support of this amendment and i will reserve. the chair: the gentleman reserves his time. the gentleman from texas. mr. burgess: i thank the chairman for the recognition. i do rise in opposition to the ellison amendment.

the chair: the gentleman controls five minutes. mr. burgess: i feel obligated to point out that the insurance companies of this country love the patient protection and affordable care act. look what happened to their stock on march 24 of 2010. it went through the roof. the reason why is they got an individual mandate not supported by any american that i know, they got an individual mandate that every man, woman, child in this country now has to purchase their product. they were suddenly released from creating products that people actually want and now you have to buy their product because the federal government tells you must and the internal revenue service is going to be the enforcer. but let's confine our remarks to the business at hand which is the ellison amendment. the amendment would require the secretary of health and human services to submit a report on the possible delays and potential enrollment reductions in health benefit exchanges. now here's a bit of irony. the reason we need this bill is

because the authors were either inadvertently provided the secretary of h.h.s. an unprecedented pass or they provide this blank check to the secretary. now this amendment would have the secretary to evaluate the impact of taking aware their authority to spend unlimited money. i wonder how they're going to rule on that. not one amendment has been offered this afternoon that would actually ask the secretary to report on how they were going to spend these funds or provide information regarding how much money the secretary actually intends to spend in this section. people should be aware that the amendment does not ask for a report on the benefit of health insurance exchanges. rather, the amendment asks the secretary to evaluate only the

-- that gives the secretary the authority to determine what plans can be sold and what benefits must be offered. the secretary's even given the authority to limit your choice of doctors. that's not rhetoric. that's section 1311-h of the patient protection and affordable care act. some states may want to create exchanges that look nothing like the centrally controlled exchanges called for in papacca. yet, this amendment only wants the secretary to report on exchanges that the secretary is charged with creating. some states may want to create exchanges that provide people real choice, actually let people keep their doctor. some states may feel that reforms other than exchanges fit their state better. i also oppose the amendment because it is a conflict of interest to ask the secretary to report on whether it believes that unlimited funding and numerous authorities to control the exchanges are a bad or a good thing. i also reject the notion that only an exchange designed and

controlled by washington, d.c., can reduce the number of uninsured. i will reserve the balance of my time. the chair: the gentleman reserves. the gentleman from minnesota has two minutes and the gentleman is recognized. mr. ellison: thank you, mr. chairman. mr. chair, why all the attacks on the secretary of health and human services? i believe our secretary of health and human services is an honorable person and no basis to attack their integrity on the house floor and that is a disgrace and a very sad occasion. this secretary of health and human services was appointed by a duly elected president, confirmed by the senate and yet the secretary has to withstand all these attacks on the integrity. the fact is this is nothing but a diversion and a distraction. this is an attack on the american people's legislation to fix this health care system. and as the gentleman goes on and on about government, look, health insurance -- denying

treatment, denying doctors. this is the tragedy the americans are living through every single day. and by the way. americans have gone bankrupt, have lost their livelihooded and have been uninsured to the tune as much as 52 million people. what is the gentleman's answer to that? we've heard nothing about this. only what's wrong. this nation, which i am proud of, that he attacks our government. this is an abomination and a sad thing. let me just say, if the insurance companies love to build so much, why would they lobby against it to the tune of $14,000 a day? i remember standing on the house floor seeing the insurance company lobbyists here every day and they spend $14 million a day to defeat the affordable care act. this is a bill according to the

gentleman he loves so much. that again is not accurate. it's untrue. this is a good amendment. it just adds a little bit of sunshine so that as the gentleman's bill to strip away this reform measure which will help exchanges -- which will help people get an exchange, get an affordable health insurance policy, as that's stripped away and snatched out of their hands at least the american people will know why and the impact of it. i yold back. the chair: the gentleman's time has expired. the gentleman from texas also has two minutes left. mr. burgess: mr. chairman, i will direct my remarks to you and try not make them personal. but i am offended that the previous speaker would say that i am attacking the secretary of health and human services. nothing can be further from the truth. but the fact of the matter is, mr. chairman, that the patient protection and affordable care act that was pushed through this congress by speaker -- then speaker pelosi and members of the democratic conference gave the secretary of health

and human services unprecedented power. every man, woman and child in this country, the most inmate aspect of their lives, is now controlled by the secretary of health and human services and further, every time in this law where it says "and the secretary shall," and i believe there are almost 2,000 of those phrases, every time it uses those words, there is a new episode of a federal rulemaking. there's thousands of pages that go into the federal register. i know most people spend part of their nights reading the federal register every evening, but for those who don't, these regulations are coming at you at an alarming rate. look, let's be honest about the insurance companies. the insurance companies love this bill. they get an individual mandate. you got to buy their product. you have no choice. it is a mandate enforced by the secretary and, oh, by the way, by the internal revenue

service. look, this is a bad amendment. let us defeat this amendment, support the underlying bill, and i'll yield back the balance of my time. the chair: all time for debate on the amendment has expired. the question is on the amendment offered by the gentleman from minnesota, mr. ellison. those in favor say aye. those opposed, no. in the opinion of the chair, the noes have it. the gentleman from minnesota. mr. ellison: request for a recorded vote. the chair: pursuant to clause 6 of rule 18, further proceedings on the amendment offered by the gentleman from minnesota will be postponed. it's now in order to consider amendment number 4 pursuant to house report 112-70. for what purpose does the gentleman from new jersey seek recognition? mr. pallone: mr. chairman, i have an amendment at the desk. the chair: the clerk will report the amendment. the clerk: amendment number 4 offered by mr. pallone of new jersey. the chair: the chair recognizes

the gentleman from new jersey. . mr. pallone: thank you, mr. chairman. i yield myself three minutes. mr. chairman, my amendment requires the comptroller general of the accountability office to study the influence of states having exchanges as opposed to having the federal government have the state's exchange. dr. burgess and i had a colloquy on this back and forth all afternoon. my whole point today has been that if we are going to have exchanges, which i know most of -- many of my republican colleagues do not want, they're not repealing the state exchanges, they're simply saying they're not going to give them any money to proceed. i think that's a very shortsighted plan because the fact of the matter is that the state exchanges would work best

if they have the flexibility and they have the money so that they can figure out what was the best way to tailor the health care exchange program to their needs in their state. my view is that by denying them that money through the state grants, we're simply letting the federal government come in and essentially run the exchange. my colleague, mr. burgess, keeps mentioning -- mentioning over and over, the secretary of health and human services is going to do this, going to do that, if that's the case why not give the states the money to do their own thing. if you don't want the health and human services secretary to control the process, let the states do their thing. the only way they're going to be able to do that is to get somebody to accomplish that goal. i mentioned my home state of new jersey has received money for these grants, they're doing demographic studies, trying to

find out who the clientele are, so they can make decisions about what kind of plans they'll have on the exchanges. this is the type of thing that's allowed and encouraged if you have state grants. without state grants, that won't be possible. all i'm saying with my amendment is to let us see what the g.a.o. says would happen if the federal government comes in and runs these exchanges rather then the states. i don't think it's going to be a good thing by comparison but i would like the g.a.o. to study it. i would point out, every -- 49 states, the district of columbia, and four territories have gotten behind the ideology and applied for exchange grants. there's almost nobody on either side of the aisle that doesn't have their state applying for grants because states know if they're going to set up the exchanges, they need the money to do it the right way. all you're doing by repealing

the grants is pulling the rug out from your own states, your own state, in almost every case, whether you're a democrat or republican. i don't want to repeat what mr. deal said, now the governor of georgia, but my colleague from texas often mentioned the governor of utah. i just wanted to read a quote from the governor of utah. he stated at a recent hearing in our committee -- i yield myself an additional 30 seconds, mr. chairman. the governor of utah stated in a recent hearing on march 1 that he was commenting on governor barbour, who was also before the committee, and he said, i am not saying it's the approach, it's an approach, i would just echo what governor barbour said, all states ought to have the opportunities to find the solution to the problem. so even the governor of utah which dr. burgess mentioned many times has said, i may not like the affordable care act, i may not like the exchanges but if you're going to have

exchanges it certainly makes sense for states to operate them and have the opportunity to do it in the right way. that's what this bill would stop. the chair: the gentleman reserves his time the gentleman from texas, for what purpose do you rise? mr. burgess: i rise in opposition to the pallone amendment. the chair: the gentleman is recognized for five minutes. mr. burgess: i yield myself four minutes. i am rising in opposition to the amendment. the description provided by the author from the rules committee states that the amendment, quote, would require the general accountability office to report on benefits of funding in setting up state-run exchanges that reflect the state's marketplace as opposed to state exchanges established and operated by the federal government, close quote. that sounds appealing enough in its own right but sort of like the health care reform law of last year, you have to read the amendment to find out what's in it. the amendment does not ask the

general accountability office to examine the benefits of state-run health insurance exchanges. rather, the amendment passed the -- asks the g.a.o. to report only the exchanges called for in the patient protection and affordable care act whose rules and structure are dominated by washington, rather than states or individuals. the amendment description speaks to, quote, setting up state run exchanges that reflect the state's plarkt place, close quote, however, talk about flexibility, state flexibility, in the patient protection and affordable care act is just that, it is merely talk. i would remind my colleagues about the golden rule. he with the gold makes the rules. let's once again look at a few areas where washington will dictate operation of the exchanges. for the purposes of comparison, let me use washington versus

austin, the capital of my state. so will washington or austin choose the essential benefits that must be paid for by individuals and families? section 1402 of the patient protection and affordable care act, says washington will. will austin or washington choose the patient protection plans? section 1402 says washington wins that round. will it be washington or austin that will select the doctors and other health care professionals allowed to provide care in the exchange plan? well, section 1311h gives that authority to washington, not austin. washington or austin, to decide if your plan's provider network is adequate, regardless of whether it covers your daughter, section 1411b gives

that authority to washington. will it be washington or austin to decide whether a plan provides linguistcally appropriate and culturally sensitive information, it gives the nod to washington. will it be washington or austin that determines if a plan a properly accredited. section 1311c1b, washington wins that round also. washington or austin, who will decide when individuals can enroll in an exchange plan. section 1311c156, washington. washington or austin, apply certification or desertification, washington wins that round. washington or austin, who do you think will win this one? judge the adequacy of an exchange internet website. that's something states should be able to decide. after all, who knows the

residents of the state than austin in the state of texas. washington actually wins that round. how about this one, washington or austin. force state government to pay for existing benefit requirement. guess what, washington, not the state, washington will be the one making that determination. then under section 1321, if the secretary determines a state has not taken the necessary steps, as determined by the secretary, to meet all the requirements set forth by the secretary, then the secretary will take over the state exchange. i think we begin to get the impression this is not state flexibility, this is of and run by washington, d.c. i reserve the balance of my time. the chair: the gentleman from new jersey. mr. pallone: thank you, mr. speaker. i yield myself such time as i may consume. my colleague on the other side, i don't understand, you are saying that you want austin to

do it, you want austin to have the flexibility to frame a program that is done best because you think that austin and the state is going to do it best? well, if that's the case, why in the world are you putting this bill on the floor? my whole point in this amendment is that by passing this bill, you are simply abrogating the right of the state to make a decision and to have the flexibility to set up a good program tailored to the state. it's the exact opposite of what you're saying you want to do. if you believe the secretary of health and human services in washington is going to make the wrong decision, i don't think she will, but if you believe that, you shouldn't be offering this bill. this bill takes away the flexability and power of austin or states to make the right decisions. it is contrary to the purpose of what you're trying to accomplish. it makes, to me, it's mind-boggling. i think what you're realy trying to do, of course, is say, let's forget about the

exchanges, defund the exchanges, let's get rid of the whole affordable care act. obviously, that would be very unfortunate because so many people will be covered at a low cost benefit package and all the benefit the anti-discriminatory packages already in place would be gotten rid of. but i would say again if you're totally opposed to the bill, that's one thing. but if you feel strongly that the state exchanges should be run by the states, then your legislation today is totally misplaced. the chair: the gentleman's time has expired. the chair reminds all members to address their remarks to the chair. the gentleman from texas. mr. burgess: i yield myself the balance of our time. patient protection and affordable care act. as seductive as the title sounds does not empower the states. in fact, it does the opposite. some states have created or are

in the process of creating state exchanges that would not meet the requirements set forth by washington. these and other states don't believe that washington knows best. i oppose this amendment. i urge my colleagues to support the underlying bill and i yield back the balance of my time. the chair: all time for debate on the amendment has expired. the question on the amendment offered by the gentleman from new jersey, mr. pallone, those in favor say aye. those opposed, no. in the opinion of the chair, the noes have it and the amendment is not agreed to. it is now in order to consider amendment number five printed in house report 112-70. for what purpose does the gentleman from vermont rise? mr. welch: i have an amendment at the desk. the chair: the clerk will designate the amendment. the clerk: amendment number five, printed in house report 112-70, offered by mr. welch of vermont. the chair: pursuant to the

rule, the gentleman from vermont, mr. welch, and a member opposed each will control five minutes. mr. welch: this congress and the last congress are at odds about health care. it's a fundamental question. the last congress passed the patient protection and aed forability act. the first act of this congress, the house of representatives, was to repeal that act. we've got disagreement about what should be done. the house legislation is pending in the senate might be going nowhere. the legislation before us today is a further effort to try to unravel the work of the law passed by the house and senate and signed by the president last year. acknowledging there's a serious debate within this body about the future of health care, this amendment would allow for the state health exchanges, where

there have been applications by 13 states for early effort grants to go forward, it would exempt from the defunding $1.9 billion that would then be subject to appropriations to that amount. it wouldn't guarantee it, it would be up to appropriations. my preference would be to make it mandatory but that wasn't in order under the rule. it allows the local state to make decisions about how best to decide their health care. and just to note some of the recitation by the gentleman from texas, the early grants have been awarded to 11 states and again, it allows them to decide what's the best design of these health exchanges. these states include what we

might call red states and blue states. it's kansas and wisconsin, maryland and massachusetts. it does include vermont, my state, that has taken on responsibility to try to move forward to design a health care system good for business, good for consumers and good for taxpayers. the fundamental question is, do you think that states can be a laboratory of experimentation in policy? the states take action, they implement a plan according to the design, in boston if it's massachusetts, in hartford if it's connecticut, or tulsa if it's oklahoma or montpelier if it's vermont. folks, if that state, where they have fundamental responsibility for the citizens of that state, will be making the decision. this allows us to look at states where they take on the responsibility, they get help from the federal government to implement these early -- these health benefit exchanges and we

are allowed then to basically get the benefit of the federal system where states make decisions, the federal government is a partner. . the chair: the gentleman from texas, for what purpose do you rise? mr. burgess: i rise in opposition of the amendment. these grants encourage flexibility by moting state control of the -- promoting state control of the changes, they say. the states can design the right health care plan for their citizens under the patient protection and affordable care act. but when you look at the law, you understand that this concept is actually not true. in reality the relationship between the states and washington, states are the servant, not a partner of washington under this health care law. the secretary of health and human services will control what benefits must be bought in an exchange.

a benevolent central planner, and i underscore the word benevolent, but a benevolent central planner will decide whether you, your doctor, your nurse, your clinic, your hospital can provide care to you through an exchange plan. an underwriter at the health and human services will determine whether your health savings account complies with their rules. the patient protection and affordable care act exchanges have only the vaneer of providing state flexibility. and they certainly rob an individual and they rob families health care choice even if they are happy with the coverage they currently have. the welch amendment does not authorize the grant program for states to establish exchanges that is exchanges written with a lower case e but rather health benefit exchanges, all caps, that are contemplated in the patient protection and

affordable care act. section 1321 of the bill has the quote, state flexibility in operation and enforcement of exchanges, closed quote, but a reading of that section shows the title could not be any more misleading. the section is littered with phrases such as, quote, other requirements the secretary determines appropriate, closed quote, or words such as, quote, the secretary determines that an electing state has not taken the actions the secretary determines necessary, closed quote. section 1311-k, i've referenced that previously, section 1311-k states that, quote, an exchange may not establish rules that conflict with or prevent the application of regulations issued by the secretary, closed quote. mr. chairman, i am encouraged that the supporter of the amendment believes we should provide -- not provide the

secretary with a blank check. however, i oppose this amendment because it perpetuates the idea that the federal government should dictate how states establish exchanges. last year we were told we need to read the bill to know what is in it. today i ask those here in this body to ignore the rhetoric and actually read the bill. those who do will see that any suggestion that the patient protection and affordable care act provides states flexibility do not hold up to the words in this 2,7hand hundred page bill. i reserve the balance of my time. the chair: the gentleman reserves. the gentleman from vermont. mr. welch: how much time do i have? the chair: two minutes. mr. welch: thank you. i want to talk a minute about social security. social security, you have access to social security whether you live in texas or you live in vermont. it's a program that benefits every single citizen of this country. and the underlying premise of social security is we're all in

it together. we all pay into the benefit program and we all benefit whether you're rich or you're poor. we're all in it together. our amendment acknowledges that this is a stronger and better country if all of us have access to affordable health care, whether you live in texas or you live in vermont. so, yes, it is true that in the welch amendment we maintain that national commitment to all americans being covered and all americans benefiting by access to health care which we know they need. but what it also does that in the implementation, in the delivery of health care, driving decisions and authority down to the local level will help us be successful. it will allow states to show that maybe they have the better way of achieving this goal, of access to health care for every citizen in the country. so, yes, i say to the gentleman from texas, we do embrace in my

amendment the concept that every american should have access to affordable health care. but we also do, i say to the gentleman from texas, is acknowledge that states can experiment, that folks at the local level may have a better way to make decisions and actually to deliver care, and if they design a plan in texas to do it one way and we design a plan to do it in vermont in another way, why not? why not let the states figure out how best to make good on this promise to america that every one of us can have access to the health care that we need? i yield back the balance of my time. the chair: the gentleman yields back. the gentleman from texas has two minutes remaining. mr. burgess: i thank the chairman. i'd just say once again the flexibility does not exist. it's a vaneer. it's a falsehood that under this plan that the states would maintain flexibility, the secretary determines whether or not the states are complying. the secretary determines a lot

the plans are in compliance with what the secretary thinks is a reasonable plan to be offered. look, if we want to talk about the ability of people to buy insurance across state lines, that's an argument that we can and should have. i don't know why your side rejected that in the debates over the patient protection and affordable care act. the fact of the matter is they didn't. we are where we are. let's defeat this amendment and support the underlying bill. i yield back the balance of my time. the chair: all time for debate on the amendment is expired. the question is on the amendment offered by the gentleman from vermont, mr. welch. all those in favor say aye. all those opposed, no. in the opinion of the chair, the noes have it. the noes have it and the amendment is not agreed to. for what purpose does the gentleman from texas rise? mr. burgess: i move that the committee do now rise. the chair: the question is on the motion to rise. all those in favor say aye. all those opposed, no. in the opinion of the chair, the ayes have it. the ayes have it.

accordingly, the committee rises. the speaker pro tempore: the house will be in order. mr. chairman. the chair: mr. speaker, the committee of the whole house on the state of the union having had under consideration h.r. 1213 directs me to report that it has come to no resolution thereon. the speaker pro tempore: the chairman of the committee of the whole house on the state of the union reports that the committee has had under consideration h.r. 1213 and has come to no resolution thereon. pursuant to house resolution 236 and rule 18, the chair declares the house in the committee of the whole house on

the state of the union for the consideration of h.r. 1214. the chair appoints the gentleman from ohio, mr. latourette, to preside over the committee of the whole. the chair: the house is in the committee of the whole house on the state of the union on the consideration of h.r. 1214 which the clerk will report by title. the clerk: a bill to repeal mandatory funding for school-based health center construction. the chair: pursuant to the rule, the bill is considered as read the first time. the gentleman from texas, mr. burgess, and the gentleman from new jersey, mr. pallone, each will control 30 minutes. and the chair would recognize the gentleman from texas. mr. burgess: thank you, mr. chairman. i yield myself such time as i may consume. the chair: the gentleman is recognized. mr. burgess: the patient protection and affordable care act included $105 billion of directly appropriated mandatory funding of numerous programs

and not provisions included in the law. for example, section 4101-a of the patient protection and affordable care act provides $50 million in mandatory spending for construction and expansion of school-based health centers every year from the inception through 2013 for a total of $150 million. in our current financial situation, it is not -- it is only not necessary but it is our responsibility that we examine all of our spending and make all necessary adjustments. h.r. 1214 is a simple bill aimed at a simple goal, to get some of the spending that the patient protection and affordable care act advanced inappropriately. section 4101-a of the patient protection and affordable care act funds only the construction of school-based health centers. the $50 million in grants are for construction only and there is an expressed prohibition on

these funds being used to provide health services. no such provision was in the bill passed by the house. if you'll recall h.r. 3200 was the health care reform act that the house of representatives worked through its committees of jurisdiction on which we held hearings, on which we had debate on the floor of the house and which passed the house in november of last year. it had no such provision in the house democrats' passed bill. and the senate democrats considered school-based health centers since no such provision was included in the health bill and if the senate democrats considered the school-based health centers important enough to receive mandatory funding, why was the mandatory funding strictly limited to the construction of the buildings? not one cent is guaranteed to see a child but automatic checks out of the treasury to build these centers. i will point out that section

4101-b of the patient protection and affordable care act created a new discretionary grant program for school-based health centers, but this grant program requires them to use the funding to provide health care services. however, the president's budget did not fund section 4101-b. failing to provide school-based health centers, money expressly for the purpose of actually providing the service. now, fundamentally we might even have some agreement on school-based health centers. i am on record of having supported them in the past and i believe opening health care -- i believe opening health care points of access is important. i want to do more in this realm, but providing mandatory spending, forced spending to construct facilities without adequate safeguards that they will provide care is irresponsible and it's certainly advocates the nature of the house of representatives. we are the people's house.

it is our obligation to oversee the money that is spent on behalf of the people of the united states. not one guarantee of a doctor, not one cent of payment for an immunization, not one ounce of common sense is included in the policy. i will note that this bill does not touch the discretionary program to provide care. i urge my colleagues to support restoring a little fiscal restrapet and a little fiscal responsibility to a small part of the law which will destroy the practice of medicine as we know it in the nation and put the taxpayer on the hook for trillions of dollars in spending. i thank the chair for your attention and i reserve the balance of my time. the chair: the gentleman reserves. the gentleman from new jersey. mr. pallone: mr. speaker -- mr. chairman, i yield myself three minutes. the chair: the gentleman is recognized. mr. pallone: mr. chairman, once again, i'm listening to my colleague, dr. burgess, who i respect, and he's talking about the common sense being lacking on the democratic side. after listening to him, i think the rationalse and the common sense is lacking on the --

rationale and the common sense is lacking on the republican side. he says he supports school-based clinics and supports federal funding for school-based clinics. then what is the rationale for opposing this bill? they say they're opposed to the entire affordable care act. yet, somehow today they're taking little pieces of the affordable care act that they even agree with, from my understanding, listening to my colleague from texas, and still saying we are going to defund them. i defy to wonder why. school-based clinics are a tremendous health stories. these provide primary care, mental health, dental services to vulnerable children across the country in every state. multiple stud ease have found these programs are cost-effective. investments. they result in lower emergency room usage, hospitalizations and medicaid costs.

in fact, patients seen at school-based health centers cost medicaid on average $30.40 than comparable to nonschool-based center patients. this is saving the federal government money. that's the bottom line. . we're providing construction, renovation for these centers. in order to get the grant for that, you have to show you have the funds to operate the center. so when dr. burgess says, why are you paying for construction and renovation but you're not paying or not providing for operation? every one of these has to show they have the money to do the operation before they get the must be for construction. what does construction and renovation mean? it means jobs. i repeat again, when i was home the last two weeks, all i heard from my constituents is, when are you going to improve the economy more? when are you going to create more jobs?

this program will create jobs, helps kids, provides for their well being and health and it's preventative. these places -- these programs have to be shovel ready to qualify for funding. so it's immediate funding. i keep hearing my colleagues say, repeel and replace. that's the mantra with the health care program. repeal it and replace it. but i never hear anything about replace. all i hear about is repeal. in this case, repealing the program is a proven success. it makes no sense to move this bill to pass this bill, i hear my colleagues on the other side say over and over again, there's four -- they're for these centers, then why bring this bill to the floor sni urge my colleagues to oppose this legislation and i reserve the balance of my time. the chair: the gentleman from new jersey reserves. the gentleman from texas is recognized. mr. burgess: i yield myself one

minute. this mandatory spending was not in h.r. 3200, the house-passed health care reform bill. make no mistake, i voted against 3200, just as i voted against 3590. but nevertheless, the bill that subcommittee chairman pallone last congress brought through did not have mandatory spending for school-based health centers in his bill. some of us get up today and act like the funding is imperative, and act like it's the only way to go. we can be the provide care unless we have money to bill build the exam rooms. but i remind my colleagues on the other side, an exam room does to the provide one ounce of care to a child. it does not save money in an emergency room visit. it is an exam room sitting unutilized because the president of the united states said i'm going to zero out the

discretionary funding for staffing these clinics. that's high this makes no sense. i urge, again, support of the underlying bill. it's important to bring this back into the authorization process. so our appropriate committees can have the oversight over the expenditure of these funds. i reserve the plans of my time. the chair: the gentleman from new jersey is recognized. mr. pallone: i yield myself such time as i may consume, mr. chairman. mr. chairman, again, dr. burgess talks about how we're spending money on construction, renovation, but we don't vo proceed -- provide mandatory spending for operations. as i said, in order to get the grant under this bill, not under this bill, under the affordable care act for construction of a school-based health center, you have to show you have the money to operate it. so what does that mean? that means we are using some federal dollars to attract either state or in many cases private dollars to set up these

centers. what is wrong with that? they are guaranteed that once the money is spept on construction and creating jobs that comes from the kruk and renovation, the money is available to operate the centers. there's nothing wrong with that. it's a good thing. it's the most federal-state cooperation, and it brings in some private dollars as well. the other thing i would point out, as you know, my colleague from texas keeps talking about mandatory appropriations. the fact of the matter is that health care initiatives over the years, democrat and republican have provided some mandatory, some discretionary. the fact of the matter is that medicare, medicaid and a lot of other federal health programs paid for health care services with mandatory expenditures. and a lot of that is for acute care. acute illness, injury, or chronic diseases. there's no similar approach when it comes to promoting

wellness, preventing disease and protecting against emergencies. now we're going to have a combination of some mandatory and some discretionary spending for a preventative program. a clinic. a center for kids in their school that helps them and prevents them from going to a hospital or an emergency room to be institutionalized. so i just think this is -- the notion of mandatory versus discretionary, bottom line, if you care about school-based centers and you want to have them, i think you should oppose this bill. the legislation that this bill is seeking to kill, the affordable care act, for the first time provides funding to put up a lot of these school-based centers. this is what we need as a preventative measure to prevent kids from having more serious problems, going to the emergency room, let's give them primary care up front so they

can stay well. i reserve the balance of my time. the chair: the gentleman from texas is recognized. mr. burgess: i yield myself one minute, mr. chairman. this language was put in the senate health care bill when the senate was giving out favors and there really was no rhyme or reason to put this program in as a program under mandatory funding. congress has traditionally provided funds to health centers, including school-based health centers to provide for care, not construction. to do it the other way around would lead to situations where a center is built but in care is delivered. both policy choices require local funds to be spent but only the policy for paying for services, not construction, guarantees money won't be wasted or worse yet never used to deliver one ounce of care. i reserve the balance of my time. the chair: the gentleman from

texas reserves. the gentleman from new jersey is recognized. mr. pallone: i yield two minutes to the gentleman from connecticut. the chair: the gentleman is recognized. >> i rise in opposition to this bill. my wife, audrey, is a pediatric nurse practitioner, she doesn't today, but through her i've gotten a chance to be exposed to the benefit of community health centers. there's no more efficient delivery system. it makes sure that kids get good, high-quality care at school, get them back on their feet, back where they belong, rather than going to emergency rooms spending hours waiting for care or being sent home in an unsupervised situation out of class which is the beauty of the school-based hell clinic. mr. courtney: it is obviously in a setting where children are located and again the turn-around in terms of making

sure they're back doing whaths good for them and good for their future is just smart -- school-based health clinic. it is obviously good for them and good for their future. i live in a place with a base, a lot of sailors, and there's a school-based clinic which is the primary care for these children. these kids move around the country, often their care is disrupted from one place to the other. having a school-based center ensures these kids have their checkups, to make sure they can enter school, that they can enter school athletic programs, and again in many instances, these military families, it is the primary health care give. 227 families, i checked with the center, get their care

through the center. this program is going to be used to ensure that the high school's footprint, in terms of the building, will be expanded, it will be an investment in information technology. mr. pallone: i yield the gentleman an additional 30 seconds. mr. courtney: they will invest in information technology to make sure this terrific, efficient, cost-effective program is going to be there, again, for families serving in libya, the mediterranean, their parents were part of the u.s.s. providence, part of the initial attack in libya. this is a program which works not only for those kids, for the community but also for our nation. i would respectfully rise in opposition to this measure which i think heads us in the wrong direction in terms of high quality care for america's kids. i yield back. the chair: the gentleman's time has expired. the chair recognizes the

gentleman from texas. mr. burgess: nothing in the bill under consideration would change anything about what was just relayed to us about the school-based clinics in the gentleman's district. can i just point out again that the discussion we're having today revolves around the use of advanced appropriations in the patient protection and affordable care act, thereby making that spending mandatory. just a brief civic lesson, medicare is mandatory spending. we have no discretion on that. we must fund medicare to the extent of the number of dollars that are going to be drawn on the federal treasury. same for medicaid. we have other health care programs that are discretionary. our veterans, who the gentleman would argue are no less worthy, are funded under a discretion mare program. the difference between a mandatory and discretionary program, is that the authorizing committee, in this

case, the committee on energy and commerce, of which i am a member, of which the gentleman from new jersey is a member, the authorizing committee sits down and decides whether or not the spending is useful. if it is, we authorize the expenditure, we send it over to the appropriations committee, who if they agree writes a check for the amount of money we have authorized and not one bit more. but the key here is it goes through a regular order process and one of the things, i don't know about the gentleman from new jersey, but what i heard when i went home is the federal spending is out of control. you've got to get a handle on federal spending. here's a point where we can get a handle on federal spending. it should have never been a advanced appropriation in the patient protection and affordable care act. i don't know if that was carelessness or macka vellian. the american people wanted us to fix that. that was one reason they voted en masse against the patient protection affordable care act

in 2010. that's one reason the gentleman is sitting in the speaker's chair today, is the public's revulsion to how the last congress conducted its business. we have a chance to reclaim a little of our honor, our integrity. let's bring that funding back into the authorization realm in which it wrongs and not simply pass it off to the administration. it's already been -- mandatory funding. it has to be done. whether or not the administration is going to fund a doctor or nurse to work in that clinic. you've got an exam bed, a thermometer, other tools but you don't have one ounce of care delivered to the people who need it, therefore you're not saving money, you're only spending money the american people have asked us to be wiser stewards with their cash. i reserve the balance of my time. the chair: the gentleman from new jersey is recognized. mr. pallone: thank you, mr. chairman. i yield two minutes to the gentlewoman from california, mrs. capps, probably me most

knowledgeable person in the house on the subject of school-based health care. the chair: the gentlelady is recognized. mrs. capps: i rise in strong opposition to h.r. 1214. as a school nurse who worked in our schools for very many years, it's been 100 days of republican rule and we have not seen a jobs bill yet. unlike -- previous efforts to ignore jobs altogether, today's bill will flat out hurt our economy and keep people out of the work force. there are children in each of our states who will if this bill passes, be deprived from having access to quality health care when they need it most. school-based health centers provide comprehensive and easily accessible preventive and primary health care services for millions of students nation withe. services that keep students healthy, in school, and learning. almost always these are children who have no other source of care. and the need is clear.

350 centers from 46 states including many in my republican colleague's district have already applied for these funds. they have taken the time and resources to compile their applications. they are excited. they are expecting to hear in just a few weeks that their project can move forward. to pull the rug out from under them now is simply a disgrace. the centers have long garnered bipartisan support, worked with many of my republican colleagues on their behalf, yet the majority is now using this as a political football in their session to repeal the affordable care act. this is a true disservice to our children and also to our community. no matter what my colleagues on the other side of the aisle say, today's vote isn't about funding or process. they don't need a civics class about it. h.r. 1214 is another attempt by them to dismantle the affordable care act. i encourage my colleagues to stop taking health care away

from children and fulfill their -- and to fulfill their political promises. vote no on this misguided bill and i yield back the balance of my time. . mr. burgess: what takes health care away from children is sending checks to localities for land acquisition when you've got no intention of staffing the clinic that is going to be built. let me remind people what the argument is about and i will stipulate that we are not talking about a vast sum of money here like we were in the previous bill. but every instance of advance appropriation in the patient protection and affordable care act represents an opportunity for this congress to reclaim some of his function as the people's house in being in control of federal spending. but here's what the argument is about. section 4101-a of the patient

protection and affordable care act under subtitle b, increasing access to clinical preventive services, paragraph 5 of 4101-a, appropriations, out of any funds in the treasury not otherwise appropriated, there is a appropriated for each of the fiscal years 2010 through 2013 $50 million for the purpose of caring -- carrying out this subsection, funds appropriated under this paragraph shall remain available until expended. no funds provided under a grant awarded in this section shall be used for expenditures, for personnel or to provide health services. it could not be clearer. now, nothing in the bill that we have under consideration today actually does anything to the provision of services because after all those are under an authorization, section 4101-b, authorization of appropriations for purposes of caring --

carrying out this section. there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2010 through 2014. but the operative word here is there are authorized to be appropriated, not that there are appropriated from the treasury, it's ok for us to authorize that appropriation. our committee is an authorizing committee. we are not an appropriating committee. mr. chairman, i understand the difference between an authorizing committee and an appropriating committee. i take an annual field trip to the national institute of health . at the national institute of health you see all these beautiful buildings, they're all built and they're named after very famous men who have served in the united states congress. every one of those men is an appropriator. there is no building named after an authorizer. still, the work we do is important, i submit it is vital to the american people that we do our work to evaluate whether or not the expenditures are

indeed in the best interest of the american people and, further, if we're really doing our job, we'll come back and do oversight over those authorizations to make sure those funds are expended in the manner in which they are intended. that's the way you guarantee that that care gets to the child that will ultimately save money to keep the child out of the emergency room, not just by sending checks to localities to purchase land. i'll reserve the balance of my time. the chair: the gentleman reserves the balance of his time. the gentleman from new jersey is recognized. mr. pallone: mr. chairman, can i inquire the time on both sides? the chair: the gentleman from new jersey has 20 minutes. the gentleman from texas has 18 1/2 minutes. mr. pallone: thank you, mr. chairman. i yield two minutes to our distinguished ranking member emeritus, mr. dingell. the chair: the gentleman is recognized for two minutes. mr. dingell: i thank my friend. i rise today in vigorous opposition to h.r. 1214. this bill is not only going to

cut access to health care for american children but it's going to kill jobs in the construction industry and construction projects around the country. more than 1,900 health care student school-based health centerses a croix the country provide access for health care services to over two million people right now. for the first time the affordable care act authorized these centers and also offered dedicated source of funding for construction renovations and equipment. 350 applicants, many of them currently running centers at this time, in 46 states, in the district of columbia, have applied for the grants including the young adults health center located in my 15th district of michigan. these grants will be used to enhance the capabilities of these centers and will jump start shovel-ready projects that will create immediate construction jobs. and allow for the purchase of necessary supplies and equipment , boosting local businesses, but

providing health care for our kids. until now operating funds are available, i would hope my colleagues on the other side will support such funding. we need to ensure that at least the facilities that are ready to apply for this kind of grant will give or do so in order to better serve our children and the communities. i think that this would be an extremely unwise bill, it's a part of an announced plan by my republican colleagues to first of all attack the whole of the health care reform bill of the last congress and then to attack it piece by piece. what they seek to do here today is just a part of another step towards health care bill which will make things better for our people and which is paid for, which is not going to add to the deficit but which in fact is going to save better than $140

billion this year and $1.4 -- another $140 billion this 10 years and in the next 10 years, $1.4 trillion. this is pennywise and pound foolish. reject the bill. the chair: the gentleman's time has expired. the gentleman from texas is recognized. mr. burgess: mr. chairman, let me just respond to something that was just said by the chairman emeritus of the democratic side of the committee on energy and commerce and of course i have all respect for the chairman emeritus and certainly treasure everyday that i served under his direction as chairman in two congresses ago. but the statement that i cannot let stand is that the patient -- patient protection and affordable care act saves anyone in any universe, in any dimension any money at all. this washington was refuted by the chief act wear for the center for medicare and -- actuary for the center of medicare and medicaid services. less than a month after the

president signed the patient protection and affordable care act and i don't know why we have to continue to hear this fairytale about $142 billion being saved. at this time i'd like to yield two minutes to the gentleman from louisiana, mr. fleming. the chair: the gentleman is recognized for two minutes. mr. fleming: i thank the gentleman and i appreciate dr. burgess allowing me to speak on this specific bill. but let's just talk about the elephant that's in the room here this afternoon. and that is the so-called afford -- affordability act, the so-called patient affordability act. we call it obamacare affectionately. folks, we've got a bill here which is now law that is at best questionably constitutional. we have a bill that's going to add another $is 1 trillion ultimately to our -- $1 trillion ultimately to our deficit.

we have half a trillion dollars that's going to be taken out of medicare and then put on both medicare extension and then on subsidy of the private health plans, even if we ever save that half trillion dollars. this whole law has questionable financing and then today we're talking about construction money that may or may not exist. so, mr. speaker, i just have to say as a physician of 30 years of practice, i was here during the health care debate in 2009 where this body has come up with, the ath and the president has signed into law -- and the president has signed into law, something that's really a disgrace, the american people are not behind it. ppaca is in some surveys opposed by the american public 2-1. it is a complete government

takeover of our health care system. just the other day i got questions from my constituents, physicians, who asked me, what about this ipad? what is that? what is this board? i had to explain to them that now when you're not sure how much you're going to be reimbursed for the health care that you provide, you can at least go to congress and petition congress. mr. burgess: i yield the gentleman an additional 30 seconds. the chair: the gentleman is recognized. mr. fleming: but under this -- under obamacare we now have ipad which is a board, a special board of unelected, unaccountable, unnamed bureaucrats that serve at the pleasure of the president who will then decide these things, creating a nonmarket responsive health care body out there that will then, we'll see much worse

shortages than what we have today. so i stand in support of congressman burgess and his bill and certainly ultimately the repeal of obamacare. thank you. the chair: the gentleman's time has expired. the gentleman from new jersey is recognized. mr. pallone: i yield two minutes to the distinguished ranking member of the full committee, the gentleman from california, mr. waxman. mr. waxman: thank you very much for yielding to me. i rise in strong opposition to h.r. 1214 and urge my colleagues to join me in voting against this very short sighted and misguided piece of legislation. this bill of course is a part of a broader republican strategy to tear down the new health reform law piece by piece. i also note that they want so tear down the existing health care laws of medicare and medicaid in their budget. well, i think that's all very disturbing but what's especially troublesome is that our colleagues on the other side of the aisle are now going after

programs where we all agree, democrats and republicans agree, that actually work, actually do a good job and make a difference . numerous studies have shown that health-based -- school-based health centers are enormously successful in helping to improve students' access to care, promote healthy behaviors among children and adolescents, improve students' academic performance, decrease school absenteism and reduce health care expenditures. with a report card like that, why wouldn't we want to build or renovate more of these centers? we should not end the school-based center construction and renovation program before it even has a chance to make its mark. i urge a no vote on h.r. 1214. i yield back the balance of my time. the chair: the gentleman yields back the balance of his time. the gentleman from texas is recognized. mr. burgess: thank you, mr.

chairman. i just point out to the gentleman what's short sighted and misguided is that this language was put in by the senate when they were giving out favors. sending checks to localities without guaranteeing the actual coverage, without guaranteeing the actual doctor or nurse be there does not do anything as far as furthering care. let me yield two minutes to the gentlelady from north carolina, ms. foxx. the chair: the gentlewoman from north carolina is recognized for two minutes. ms. foxx: thank you, mr. speaker, and i thank my colleague from texas for yielding time. the american people know that we are borrowing 43 cents for every $1 we spend this these days -- spend these days. we do not need to be giving grants of dollars that we have collected from hardworking taxpayers to local entities to build or renovate school-based health centers. this is not a core function of

the federal government, it's not a core function of our taxpayers. we do not need to be spending this money like the majority want -- minority wanted to spend it when they were in the majority. it's also very duplicative, mr. speaker. between the stimulus bill and what we affectionately call obamacare, $3 billion in funds have been made available to health resources, service administration at the department of h.h.s. for facility improvements at community health centers. providing an additional $50 million a year for construction is duplicative and unwarranted. this bill deserves the support of every member here. we're soon going to have to have a vote to raise our debt limit. people say oh, -- over and over again on both sides of the aisle, we have to cut spending,

we have to cut spending. what better place to start than, in these funds that are going out for a function that is not appropriate for the federal government to be involved in, so that we don't have to continue to borrow 43 cents for every $1 that we spend? so i think we should cut out duplicative programs and this bill definitely needs to pass and i give it my full support. i yield back. the chair: the gentlelady yields back the balance of her time. the gentleman from new jersey is recognized. mr. pallone: i yield two minutes to the gentlewoman from the virgin islands. the chair: the gentlelady from the virgin islands is recognized for two minutes. mrs. christensen: thank you. here we go again. this time attacking a provision in the affordable care act that would help to reach children and especially teens who otherwise might not have access to important health care services. and so, mr. speaker, today i join my democratic colleagues who speak on behalf of our children and against h.r. 1214.

our future depends opt development of healthy, well ed cated children. unfortunately often our children miss school or sit in class too distracted to pay attention because the preventable and treatable health conditions that have caught early and treated as these school-based health centers would do, would enable them to better learn and to reach higher levels of achievement. . if we really care about our children, why are we considering this legislation that will harm them, not in the future but today. eliminating funding for school-based health centers would not just prevent a building from being built but would eliminate the creation of the only medical home that many students know, which creates access to needed mental, physical, and dental care. they provide services that many students cannot or would not access anywhere else and they provide a service to the

featurers to focus on teaching these students. taking away the funding, would be a step in the wrong direction, not just for the health and well being of our children but for our country's ability to win the future. i want to say we did not pass any bill affectionately known as obamacare. the affordable care act is about the people's care. i urge my colleagues to vote for our children and vote no on h.r. 1214. the chair: the gentlelady yields back. the gentleman from texas is recognized. mr. burgess: i yield three minutes to the chairman emeritus of the full committee of energy and commerce, mr. barton of texas. the chair: the gentleman is recognized for three minutes. mr. barton: thank you, mr. speaker. -- mr. chairman, i ask unanimous consent to revise and extend. the chair: without objection. mr. barton: i want to read the section of the law we're trying to repeal today.

subparagraph 5, appropriations. out of any funds in the treasury, there is to be appropriated each year 2010 through 2013, $50 million for carrying out this subsection. funds appropriated under this paragraph shall remain available until expended. in this subsection's definition, school-based health centers and sponsor facilities have been given those terms under such and such and such and such. we are trying to repeal $a million a year for four fiscal year, 2010, 2011, 2012, and 2013, for these school-based health clinics. i support school-based health clinics. dr. burgess supports school-based health clinics. we both represent part of tarrant county.

the public hospital is john peter smith, there are a number of school-based health clinics in my district, his district, congresswoman granger's district, but we believe the state and county should provide the facilities, the federal government should provide the funds to staff it. we don't believe when we have a $1.5 trillion deficit each year that we need to be spending another $a million or $200 million over four years to actually provide the facility, to provide construction. so it's not in opposition to the health clinic itself, school based, i've gone to openings, i support them, i think they do excellent work, but until we get our budget balanced, mr. speaker, i think it's prudent to not require the federal government, to not only fund the operation and the staffing but also fund the construction in the facility

itself. so this is a case where we're specifically repealing a specific appropriation, in this case, $50 million a year for the years 2010 through 2013 fiscal years and i think that is something that with a $1.5 trillion budget deficit is a prudent thing to do. so i rise in strong support of the bill and at the appropriate time would urge a yes vote. with that, i yield back the balance of my time. the chair: the gentleman from texas yields back. the gentleman from new jersey is recognized. mr. pallone: i yield two minutes to the gentleman from virginia, mr. moran. the chair: the gentleman is recognized for two minutes. mr. moran: i thank my good friend from new jersey. as my friend from texas well knows, the recipients of this money have already shown that they have the operations and maintenance money available. but they can't establish a school-based health clinic without this funding. the other thing that i'm sure they're well aware of is that

the need is many times more than the money is and the money being made available. 40 years ago, when i set up a school-based health clinic, in alexandria virginia, people said that's in the needed and we can't afford it. we now have 40 years of experience and we found the opposite. it is absolutely needed abwe can't afford not to have school-based clinics. adolescents need to have affordable health care. they don't go to doctors or hospitals until it's too late. we have more than 1,000 students use the clinic. we're told by nurses 80 pk to 90% of them would have to go to the emergency room if that clinic was not available, at far greater cost. it saves money and it saves lives, her friend's leg was

bothering her, she went to a doctor for -- to the clinic for something else, and they checked her leg and it was bone cancer. that's what adolescents do. they go in for the flu, they get checked for sexually transmitted infections, get their physicals. hundreds of students, around the country there are hundreds of thousands of students who don't have the opportunity actually to play in athletics because they have to have a physical finance and it's $75 to go to the doctor to have a physical exam. they don't get it. so they go to a health clinic, get the commam, then they can fully participate. a lot of children tell the doctors and nurses things they couldn't tell their parents. we're saving lives with this, we're saving money, we're doing the ithe thing by the american people particularly adolescents, they need accessible health care, this

provides it. the chair: the gentleman from texas is recognized. mr. burgess: thank you, mr. chairman. at this point, i'd like to yield one minute to the gentleman from georgia, mr. grace. mr. graves: only in washington can spending money lead to saving money. but i think about the impact obamacare is having on the state of georgia. this year, $100 million it's cost the taxpayers, projected to be more than that in the next years. i support full repeal of the program, already demonstrated that through my vote. this is specifically getting rid of a slush fund that's in place, eliminating funding for the construction of facilities in local communs. and i'm sure this is a laudable program in many areas and there's probably a lot of laudable programs that folks want to fund but the fact is, we just can't do it. we don't have the resources to do it anymore. we need to find out what is the

true role of this federal government. i do not believe this is it. we should allow the state and empower the states who are best equipped to handle the needs of the local community and i support this measure and urge my colleagues to vote yes on h.r. 1214 and let's move on to repealing the full measure of obamacare. the chair: the gentleman yields back. the gentleman from new jersey is recognized. mr. pallone: i yield two minutes to the gentleman from new york, mr. engel. the chair: the gentleman is recognized for two minutes. mr. engel: i thank my friend for yielding to me. give me a break. i hear speaker after speaker on the republican side saying we don't have the resources to do these things. it seems we have the resources to give tax breaks to the rich, we don't worry so much about the budget deficit when it comes to protecting our rich friends. the republicans two weeks ago spent passing bills, putting medicare and medicaid in jeopardy and now they would

deny these communities health centers. they don't bring bills in the majority to help create jobs in this country but still once again here we are for the god knows how many time, with a bill trying to kill affordable health care act. again it's political theater. it's not going to pass the senate. the president would veto it. let's put our heads together a and to something constructive instead of saying no to health care. the value of school-based health centers is well known. there are 1,900 in the country. they provide access to high quality, comprehensive health care. the services are provided regardless of the student's ability to pay and are provided right where they are at school. in my district, these are very important, even the high school in which i graduated as a -- has a wonderful center, it's the kind of program we should be promoting and replicating. instead, we have a bill that

will repeal funding for construction of these centers. the agency monitoring is concerned about the sustainability of the health center. the health resources and services administration have seen the sustained success of those programs and only support those programs that will have long-term success. let's be honest. today's debate is not on the sustainability of these centers or mandatory spending. today's actions are simply one more attempt by republicans to undermine the affordable health care act. we're wasting time again and again and we should stop. the affordable health care act makes health care affordable for the middle class. i'm for quality health care, we should vote no on h.r. 1214. the chair: the gentleman from texas is recognized. mr. burgess: i thank the chairman. i would agree it is easy enough to bat -- this is a bill that

-- this is an uphill battle in the senate. i also say that the president has not issued a veto threat against this legislation. i recognize the gentleman from georgia for two minutes. the chair: the gentleman is recognized for two minutes. mr. graves: i thought the gentleman wanted -- >> i thought the gentleman wanted to speak in support of h.r. 1214. we have to remember we're in our third year of $1.6 trillion deficit. that's right, the op because ma administration has put us in our third year of a deficit of $1.6 trillion. for every dollar we spend, 40 cents is borrowed. mr. kington: at what point will that mean anything to our democrat colleagues. do you really believe you can defy gravity other and over again and it's not going to come back to haunt you? i don't understand it. i'm baffled by this.

we've got a deficit we have to consider for future generations. number two, the stimulus bill has $3 billion, the stimulus bill and obamacare have $3 billion that went to the health resources service administration, at the department of health and human services, for impruflte in community health centers that many of these school-based health care clinics are eligible for. this is strictly a duplication. $50 million on top of $3 billion. number three, as an appropriator, i believe we have to be very careful about advance appropriations. this goes to the 2014. if it is so good as we have heard, and surely there is a level in which you can argue the effectiveness of these but if it is so good, why not let them get in line as soldiers have to, as educators have to, as hospitals have to, as researchers have to, as everybody else who gets federal government money, let them get in line each and every year and

justify their budget. and then, congress, weighing it out will say, let's fund it again this year. but what the democrats are asking us to do is obligate future congresses through the year 2014 on money that's put in on automatic pilot. that's not fair, that's not right. in these budget times again when we are borrowing 40 cents for every dollar we spent, we do not need to -- mr. burgess: i yield the gentleman 30 seconds. mr. kings spon: i appreciate it. they can justify their budgets each and every year just like the soldiers have to and everybody else has to. for those three reasons, i strongly support h.r. 1214. the chair: the gentleman from new jersey is recognized. mr. pallone: mr. chairman, i yield myself 30 seconds. i've listened to my colleague from georgia, mr. kingston, i

can't believe he's blaming the deficit on president opaw ma. we had eight years, two wars all of the giveaways to millionaires and the special interests and now all of a sudden it's obama that -- we're talking about $50 million a year for probably one of the best programs you can imagine, $50 million a year for some of the best use you can imagine, and the gentleman is talking about the deficit. i yield two minutes to the gentleman from california, mr. miller. the chair: the gentleman is recognized for two minutes. mr. miller: i rise in opposition to h.r. 1214 and its impact on our schoolchildren. school-based health centers have gotten wide support because they ensure students are healthy. in these centers, hin get health services when they need

them. they can't learn when they're chronically sick or have a titheache or chronic health problems. for too many children, a school-based health center may be the only opportunity to receive needed care. this is particularly the case with with oral health. tooth decay is the leading cause of disease in children. 80% of times it happens in children who have problems accessing care. that's why school-base health programs are so porn. that's why we're a strong supporter of this program. states also believe these creners are needed. indiana's superintendent recently testified before the education work force committee that districts are prioritizing school-based health centers because they have made a difference in the lives of those children. . in my district, a unified school has two health centers and four

in development. the legislation before us today could essentially halt the development these centers by repealing the funding made available by the affordable care act. that is a fund that is critically important to these schools so that they can provide these centers. the federal government shouldn't randomly yank the support for school health centers, they should be letting the school districts make the decisions based upon their identified need. this bill is nothing more than a continuation of the attack against the beneficiaries of the affordable health care act. those who will benefit from it, where they're senior citizens or whether they're young children, we ought not to support this legislation. the chair: the gentleman yields back the balance of his time. the gentleman from texas is recognized. mr. burgess: mr. chairman, may i just inquire as to the amount of time that's left? the chair: the gentleman from -- >> i thank the gentleman for yielding. i want to respond to my friend from new jersey. it's very important if we added up the bush deficits in those years, certainly the bush administration overspent

absolutely no question about it. mr. kingston: the republican party overspent. not to be outdone, in one year the obama administration ran up the numbers higher and one year in deficits than the bush did in eight years. it's outrageous. the year that the democrats won the majority, the bush deficit was $160 billion. i agree, way too high. but what did they do? $1.6 trillion. that's a lot of money and that's all the more reason that we need to eliminate duplicative spending which is what this is. support h.r. 1214. thank you. the chair: the gentleman's time has expired. the gentleman from texas reserves. the gentleman from new jersey is recognized. mr. pallone: mr. chairman, i yield two minutes to the gentlewoman from california, mrs. davis. the chair: the gentlewoman from california is recognized for two minutes. mrs. davis: thank you. thank you, mr. speaker. mr. speaker, this bill will not create one job or help one american family cope with high gas or grocery prices. but i tell what you it will do.

it will make it more difficult for over one million children to see a doctor or a nurse. in december central elementary school in san diego opened a school-based clinic to give access to 860 children. 25% of those children are uninsured. now central students will get care when they need it. and they won't have to miss scool school for an appointment. this clinic is a dream come true, says central's principal. any principal knows that unaddressed health or mental health problems are enormous obstacle to student learning and student attendance. many children have ongoing health problems causing crnic absenteeism such as diabetes that you can treat right at a school clinic and every child, every child needs care for illnesses that can spread to an entire classroom. my colleagues clearly didn't

consult too many school principals while riding -- writing this misguided bill. please, vote against taking health clinics away from kids. i yield back the balance of my time. the chair: the gentlelady yields back the balance of her time. the chair recognizes the gentleman from texas. mr. burgess: thank you, mr. chairman. i yield myself one minute. the chair: the gentleman is recognized. mr. burgess: the federal deficit is now the biggest concern of business economists and the american people at large. job creators are sitting on the sidelines while washington continues to spend more money than it -- that it doesn't have. despite the sobering fact, my colleagues on the other side of the dice in the energy and commerce committee have not proposed a single cut, not one single spending cut under our committee's jurisdiction. sure, i can be criticized today for only trying to save, what, $200 million? i don't know about new jersey, but in my district back in texas, $200 million is still real money. you know, last week's subcommittee markup, all

chairman waxman could come up with was tax increases and cuts to the farm program. we can and should do more to get our spending under control, our committee, the committee on energy and commerce, has an obligation to be front and center in that fight. i'll reserve the balance of my time. the chair: the gentleman yields back the balance of his time. the gentleman from new jersey is recognized. mr. pallone: mr. chairman, i yield myself 30 minutes. for the -- 30 seconds. from the very beginning today, dr. burgess, i said and many of us have said that affordable care act saves money and that school-based centers save money. the c.b.o. estimates over $1 trillion in savings from the affordable care act. $30.40 less than medicaid costs for a kid that goes to a school-based clinic. by repealing this funding for school-based clinics, you're going to cost the federal government more money. don't talk to us about the deficit. we save money with our legislation and you're spending more money by proposing this

bill. i yield two minutes now to my colleague from new jersey, mr. andrews. the chair: the gentleman from new jersey is recognized for two minutes. mr. andrews: i ask unanimous consent to revise and extend my remarks. the speaker pro tempore: without objection -- the chair: without objection. mr. andrews: thank you, mr. chairman. i thank my friend for yielding. there are nearly 15 million unemployed people in america and i think most of them and those who are employed would tell us that what they want the congress to be doing is finding ways to work together so that businesses and entrepreneurs can create jobs for the american people. here we are again, arguing about the health care bill or another piece of it and this legislation has behind us the novel idea that if children get immunizations and well visits and get to see a nurse or a doctor when they're not feeling well, that that somehow is not a wise use of the public's money. now, let's put aside for the moment the idea whether it's right or wrong to deny health

care coverage for children in schools, i think it's very wrong, and let's look at the balance sheet. which is more expensive? a child who's hospitalized with pneumonia or 25 or 30 children who get a checkup? which is more expensive? the outbreak of a flu that affects the entire school or the entire town or the early diagnosis and treatment with antibiotics of a kid with the flu? common sense says that primary care for children saves money for everyone. common sense says that children without insurance can most lease -- easily be reached in the school or hopefully they already are. voluntary participation by children in a school with their parents' consent makes perfect sense. this legislation, it make noes sense to consider it now, it makes even less sense to pass it. i would urge a no vote on this legislation and urge the house

to get back to the business of working together to help entrepreneurs create jobs for the american people. i yield back. the chair: the gentleman yields back the balance of his time. the gentleman from texas is recognized. mr. burgess: i yield myself 30 seconds. again, let me remind people what we are talking about today. we are talking about taking away advanced appropriations in the patient protection and affordable care act for construction purposes, not for running the darn clinic, but for construction purposes. an eligible entity should use funds provided under a grant only for expenditures for facilities. no funds provided under a grant awarded in this section shall be used for expenditures for personnel or to provide for health services. i yield one minute to the gentleman from indiana. the chair: the gentleman from indiana is recognized for one minute. mr. burton: -- mr. boucher: thank you. i rise. this is -- mr. bucshon: thank

you. this is another slush fund of mandatory spending in the bill, $200 million with no congressional oversight over the next four years, where the secretary of health and human services can grant construction and renovation for school-based health centers, again at their own discretion. again, as was just stated, none of this money can go to actually providing health care. it's deseptember to have say that this section of the obamacare bill is to promote health for our students and others at schools. this is another indication of uncontrolled federal government spending with no congressional oversight and i speak today on behalf of the bill to rescind that and with that, mr. speaker, i yield back the balance of my time. thank you. the chair: the gentleman yields back the balance of his time.

the gentleman from texas has 3 1/2 minutes remaining. the gentleman from new jersey has four minutes remaining. the gentleman from new jersey is recognized. mr. pallone: mr. chairman, i have no additional speakers. i don't know if the gentleman from texas haas does and i'll reserve at this time if he does. the chair: the gentleman from new jersey reserves. the gentleman from texas is recognized. mr. burgess: with i yield myself 30 seconds. the chair: the gentleman is recognized. mr. burgess: we just heard a moment ago from the gentleman from new jersey, per pet situation of the fantasy that the patient protection and affordable care act is going to save anyone in this universe or a parallel universe or a parallel dimension any money. make no mistake, this bill, this law costs vast sums of money. when the subsidies in the exchanges hit, the tap on the federal treasury is going to be unlike anything this country has ever seen. congressional budget office talk about saving money was pure fantasy, the chief act wear for

the center for medicare and medicare services exposed that fantasy for what it was less than a month after congress voted on this bill. we voted on this law without actually having correct information because i believe the secretary with held that information from us. i'll reserve the balance of my time. the chair: the gentleman from texas reserves. the gentleman from new jersey is recognized. mr. pallone: i'll yield myself two of the four minutes. we'll go back and fourth with dr. burgess here. look, the fact of the matter is that congress uses the crob as the official statement -- c.b.o. as the official statement if you will of our budget and the cost of legislation. that's what we've all agreed on a bipartisan basis we're going to use. i don't know -- i don't always agree with c.b.o. you've heard me many times say that they don't score prevention enough. the fact of the matter is that's what we're going to use and we've all agreed and the c.b.o. says that the affordable care act saves over $1 trillion over the life of the bill. look, everyone knows and i know that dr. burgess even himself

believes in preventive care. that's what these school-based health clinics are all about. they work. they get kids into the clinic, the center thrks, they get primary care, they prevent having to go to an emergency room, to a hospital or i don't know what else. any other kind of institutionalization. this is what we're trying to do with the affordable care act. we're trying to save money by guaranteeing people get to see a doctor when they need one. so they don't get sick. it's all about wellness. that's what it's about. and wellness saves money. the federal government doesn't have to spend the money when the person goes to the emergency room and doesn't have any insurance coverage. it's that simple. i've had this argument many times with dr. burgess. i think for the most part he agrees with me and he's even said today he thinks the school-based centers are a good thing. so i really don't understand the basis of this legislation that's being proposed this evening. and i certainly would urge my colleagues to vote against it. i reserve the balance of my time. the chair: the gentleman

reserves the balance of his time. the gentleman from texas is recognized. mr. burgess: mr. chairman, i'll reserve the balance of my time. the chair: the gentleman from texas reserves. the gentleman from new jersey is recognized. mr. pallone: mr. speaker, how much time is left? the chair: the gentleman from new jersey has 2 1/2 minutes, the gentleman from texas has three minutes. mr. pallone: i'll close at this time and use my time. the chair: the gentleman from new jersey. mr. pallone: mr. speaker, i have said over and over again i don't understand what the republicans are up to today. they keep saying that they want to repeal the affordable care act, that the health care reform. they keep bringing bills to the floor on a regular basis that would either in a piecemeal or in a large fashion repeal the affordable care act. but the arguments make less and less sense every day as they start to take the pieces of the legislation that they even agree with themselves. today we've been here for many hours, my colleague from texas and others said t