the speaker pro tempore: pursuant to clause 8 of rule 20, the chair will postpone further proceedings today on the motion to suspend the rules on which a recorded vote or the yeas and nays are ordered or on which the vote incurs objection under clause 6 of rule 20. any recorded vote on the postponed question will be taken later. for what purpose does the gentleman from missouri seek

recognition? >> mr. speaker, i move to suspend the rules and pass the bill s. 990 with an amendment to provide for an additional temporary extension of programs under the small business act of 1958 and for other purposes. the speaker pro tempore: the clerk will report the title of the bill. the clerk: senate 990, an act to provide for an additional temporary extension of programs urn the small business act and the small business investment after of 1958 and for other purposes. the speaker pro tempore: pursuant to the rule, the gentleman from missouri, mr. fwraves and the gentlewoman from new york, ms. velazquez each will control 20 minutes. mr. graves: i ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous material under the bill in question. the speaker pro tempore: without objection, so ordered. mr. graves: i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized.

mr. graves: america's 27 million small businesses drive the u.s. economy. those small businesses have created 64% of our net new jobs over the last 15 years. strong, vibrant economies are built from the ground up and as our nation's entrepreneurs are making decisions to take risks and invest, they need to know their elected officials are looking out for them and providing them with the certainty they need to have confidence moving forward that confidence will result in increased economic output and a better way of life for all american thesms legislation we have before us is a simple extension of programs overseen by the small business administration through september 30, 2011. the current authorizing legislation expires at the end of this month and we need additional time to continue our legislative work. chief among the programs we're extending today is the small business act. earlier this month the small business committeed held a

markup of legislation that would fully authorize the sbir program through 2014. this bipartisan legislation passed our committee by voice vote an we are ready to bring this legislation to the floor to voproo -- provide our small entrepreneurs with the certaintied they need to move forward. unfortunately, the long-term re-authorization introduced by our counterparts in the other body remains staaled. we reached out on finding a solution to fully authorize the sbir program as well as other important small business initiatives. it is my hope we can continue to work in a bipartisan and bicameral way to pass this long-term re-authorization. i urge my colleagues to vote yes on s. 990 as amened and reserve the plans of my time. the speaker pro tempore: the gentlewoman from new york is recognized. ms. velazquez: i yield myself such time as i may consume. the speaker pro tempore: without objection. ms. velazquez: the economy is

showing signs of recovery on several fronts, adding one million jobs in the last six monts. while this is good news, we have a long way to go and this is why we need small firms more than ever. small businesses which create 2/3 of new jobs drive the employment gain and economic expansion. time and time again they have generated the ideas and know-how that spark job growth. however, entrepreneurs must have the resources and tools they need to start up our expand. the legislation we're considering today provides them and extends the authorization of small business administration programs. for many firms, this initiative -- these initiatives are critical, enabling them to secure financing and more effectively compete for federal contracts. while we must keep the programs operational, it is unfortunate we are doing so through another temporary extension.

howevers, it is my hope we can reach a lasting agreement on the agency authorization so we do not have to come back here again in a few months. small businesses across the nation depend on a strong smplet b.a. this is especially true now when many unmed individuals are turning to this as a source of income by ensuring the agency's programs do not last, we are providing small businesses with a foundation for future growth and in doing so helping move the economy forward. i urge a yes vote and reserve the balance of my time. the speaker pro tempore: the gentlewoman from new york reserves. ms. velazquez: i yield back the balance of my time. the speaker pro tempore: the gentlewoman yields back the balance of her time. the gentleman from missouri is recognized. mr. graves: mr. speaker, in closing, let me reiterate that small businesses can and will lead our economic recovery. this is a strong case for fully authorizing the sbir and other programs.

they have a proven track record of creating jobs and solving federal agency problems. they provide a bridge between product conception and marketability and a step of vital importance for innovative ideas to become a reality. the new technologies an discoveries that come out of these programs go a long way toward kirpge competitive edge in the world marketplace and these programs are the kind of public-private partnership that's essential to the growth of our economy. i look forward to working with ranking member velazquez and our colleagues in the other poddy in the coming months. with that, i yield back the balance of my time. the chair: both -- the speaker pro tempore: both sides having yielded back their time, the question is, will the house suspend the rules and pass h.r. 990 as amended. those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 being in the affirmative, the rules are suspended, the bill is passed and without objection the motion to reconsider is laid on the table.

the speaker pro tempore: for what purpose does the gentlewoman from north carolina rise? ms. foxx: mr. speaker, by direction of the house republican conference i send to the desk a privileged resolution and ask for its immediate consideration. the speaker pro tempore: the clerk will report the resolution. the clerk: house resolution 274, resolved, that the following named member be and is hereby hechted to the following standing committee of the house of representatives, one, committee on education and the work force, mr. goodlatte, rank immediately after ms. foxx. the speaker pro tempore: without objection, the resolution is agreed to and the

motion to reconsider is laid on the table. for what purpose does the gentlewoman from north carolina seek recognition? ms. foxx: mr. speaker, i ask unanimous consent that the proceedings during the recess be printed in the record. the speaker pro tempore: without objection, so ordered. the gentlewoman from north carolina is recognized. ms. foxx: thank you, mr. speaker, by direction of the committee on rules, i call up house resolution 269 and ask for its immediate consideration. the speaker pro tempore: the clerk will report the resolution. the clerk: house calendar number 39, house resolution 269, resolved that at any time after the adoption of this resolution, the speaker may, pursuant to clause 2b of rule 18, declare the house dissolved into the committee of the whole house on the state of the union for consideration of the bill h.r. 1216 to amend the -- to

amend the public health service act to convert funding for graduate health education from direct appropriations to an authorization of appropriations , the first reading of the bill shall be dispensed with. all points of order against consideration of the bill are waived. yen debate shall be con fin fen -- confined to the bill and shall not exceed one hour equally divided and controlled by the ranking member of the committee on education and commerce. after general debate, the bill shall be considered for amendment under the five-minute are rule. 24e bill shall be considered as read. all points of order against provisions in the bill are waived. no amendment to the bill shall be in order except those received for printing in the portion of the congressional record designated for that purpose in clause 8 of rule 18 in a daily issue dated maye 23, 2011, and except pro forma amendments for the purpose of debate. each amendment so received may be offered only by the member who caused it to be printed or a designee and shall be

considered as read if printed. at the conclusion of consideration of the bill for amendment, the committee shall rise and report the bill to the house with such amendments as may have been adopt. the previous question shall be considered as ordered on the bill and amendments thereto without intervening motion except one motion to he re-commit with or without instructions. section 2, at any time after the adoption of this resolution, the speaker may, pursuant to clause 2 it is b of rule 18, declare the house resolved into the committee of the whole house on the state of the union for consideration of the bill h r. 1540, to authorize appropriations for the fiscal year 2012 for military activities of the department of defense and for military construction. to prescribe military personnel strength for fiscal year 2012 and for other purposes. the first reading of the bill shall be dispensed with. all points of order against consideration of the bill are waived. general debate shall be confined to the bill and shall not peed one hour equally

divided and controlled between the chair and ranking member of the armed services committee. after consideration of the debate, the committee of the whole house on the state of the union shall rise. no other consideration of the bill shall be in order except pursuant to a subsequented or ore they have house. section three, the requirement of 6a of clause 213 is waived with respect to any resolution reported through the legislative day of maye 27, 2011, providing for consideration or disposition of a measure addressing expiring provisions of the u.s.a. patriot improvement and re-authorization act of 2005. the speaker pro tempore: the gentlewoman from north carolina is recognized for one hour. ms. foxx: thank you, mr. speaker. for the purposes of debate only, i yield the customary 30 minutes to the gentleman from massachusetts, mr. mcgovern, spending which i yield myself such time as i may consume.

the speaker pro tempore: without objection, the gentlewoman is recognized. ms. foxx: during consideration of this resolution all time yielded is for the purpose of debate only. mr. speaker, i ask unanimous consent that all members have five legislative days to revise and extend their remarks. the speaker pro tempore: without objection. ms. foxx: house resolution 269 provides for modified open rule providing for consideration of h.r. 1216 which amends the public health service act to convert funding for graduate medical education and qualified teaching health centers from mandatory spending to an authorization of appropriations. h.r. 1540, the national defense authorization act, and same-day consideration of the rule to consider extending certain provisions of the u.s.a. patriot act. mr. speaker, this is the seventh modified open rule that the house republican majority has offered this congress. compared to the liberal democrats' one modified open rule during the entire 111th

congress. the first underlying bill today, h r. 1216, continues the fulfillment of the republican pledge to america and illustrates that once again republicans are keeping our proppingses to the men -- promises to the american people to cut federal spend. the american people want transparency of washington spending of hard-learned -- hard-earned taxpayer dollars. the federal government is spending one out of $4 of gross domestic product. we hear the term federal money, mr. speaker, as though it is manna from heaven. let me dispem pell that misconception, mr. speaker. the federal government has only the money it takes away from hardworking american families through taxes or the money it borrows. as a nation, we are current libor roing 43 cents for every $1 spent at the federal level.

some argue that to balance the federal government and pay down the debt we should raise taxes. as a fiscal conservative i disagree. raising taxes is simply a way to pass the blame. we must rein in out-of-control washington spending and put an end to it. the american people are sick and tired of reckless government spending and washington's disregard for basic budgeting principles of living within its means. this is one of the many reasons i urge my colleagues to support this rule and the underlying bill before us today, mr. speaker. h.r. 1216 restores congressional oversight to federal spending by ending the autopilot spending for physician residency programs at teaching health centers and restoring it to the annual appropriations process. when a program was put on autopilot, congress advocating its authority to unelected bureaucrats and takes a handsoff approach. house republicans are committed to ending that approach to

federal spending and ensuring that government programs are accountable for how they are spending money. no longer will we accept politically popular excuses. each program must prove that it is a wise steward of taxpayer dollars. if congress will not address out-of-control spending now, we're passing the butt to our children and grandchildren. therefore therefore, i commend my american colleagues at the house energy and commerce committee for seeking to end mandatory or autopilot funding for the programs in the liberal democrats' government takeover of health care. because the liberal elites knew our government particularover of health care was unpopular and would likely have consequences at the ballot box, they included $105 billion in mandatory taxpayer spending in the law itself to protect their favorite programs. let me take a moment, mr. speaker, to explain the difference between discretionary and mandatory government spending. discretionary spending is

appropriated by congress annually and, therefore, subject to congressional oversight and review. discretionary spending allows members of congress the opportunity to be wise stewards of the taxpayers' money by not funding ineffective or duplicative programs. on the contrary, mandatory spending operates irrespective of congressional appropriations and must be spent whether we have the money or not. the most recognized mandatory spending programs are medicare, medicaid and social security, which operate on autopilot and have not been subject to congressional oversight from year to year as funds automatically stream from the treasury to anyone who qualifies for a particular benefit. it cannot be emphasized enough that the liberal elites in washington chose hastily to ram through their government takeover of health care with no regard to the staunch opposition of the american people. the audacity of an elected official or worse an unelected

bureaucrat basically saying to a taxpayer that he or she knows how to spend the taxpayer's money better than the individual taxpayer is appalling. that is why the ruling liberal elites in washington did when -- that is what the ruling liberal elites in washington did when they chose to forgo the annual appropriations, also known as oversight process, by putting their favorite programs on autopilot under obamacare. mr. speaker, it's my firm belief that washington should not be in the business of picking winners and losers. during committee consideration of the underlying bill, my republican colleagues pointed out that the liberal democrats in control last congress put the funding for residencies at teaching center -- teaching health centers on autopilot but left residency programs at children's hospitals to fend for themselves in the annual appropriations process.

in fact, president obama's f.y. 2012 budget proposes eliminating funding for residency programs at children's hospitals. mr. speaker, it's hard to understand that residencies at teaching hospitals should receive special treatment. why were these residency programs while others languished and eventually were poe posed to be eliminated? this is a classic example of washington bureaucrats deciding which programs will win and which will lose. as i said earlier, every program should be properly scrutinized by congress through the appropriations process and be accountable for how it is spending taxpayer money. while this accountability should als be important, it's even more critical because we're facing the third straight year of trillion-dollar deficits. this fiscal year our deficit will be $1.6 trillion. mr. speaker, remember the

figure i mentioned earlier about our nation's borrowing habits? we're borrowing 43 cents of every $1 the federal government spends. this translates to a national debt that has reached more than $14 trillion and has gotten the attention of the american people. if you're having a hard time visualizing $14 million, let me help you. each citizen, man, woman and child, would owe more than $46,000. the simple truth is that we have a spending crisis in this town due in large part to mandatory spending that operates on autopilot. house republicans are committed to bringing government spending under control, and we're continuing to build on our pledge to america by restoring congressional oversight and accountability for government programs. again, mr. speaker, i urge my colleagues to vote for this rule and the underlying bills

and i reserve the balance of my time. the speaker pro tempore: the gentlewoman from north carolina reserves. the gentleman from massachusetts is recognized. mr. mcgovern: thank you, mr. speaker, and i want to thank the gentlelady from north carolina, my friend, dr. foxx, for yielding me the customary 30 minutes, and i ask unanimous consent to revise and extend my remarks, and i yield myself such time as i may consume. the speaker pro tempore: without objection, and the gentleman is recognized. mr. mcgovern: mr. speaker, this rule allows for the consideration of h.r. 1216, the graduate medical education direct spending repeal act, and general debate for h.r. 1540, the national defense authorization act for fiscal year 2012. and this rule also allows for a martial law reconsideration of the patriot act sometime this week. frankly, mr. speaker, this is a disappointing rule. while i have no problem with the rule providing for general debate for the defense authorization bill, it is disappointing that this rule also includes these two other provisions, especially the martial law rule. let me begin with h.r. 1216.

this bill is simple. it's another chance for the republicans to dismantle the affordable care act. it's one more part of their repeal agenda. the funny thing is, mr. speaker, republicans continue to push their repeal agenda but they have not put any plan forward to replace these new health care protections that we passed. the truth is that the rpts are not only trying to -- republicans are not only trying to repeal the affordable care act, they're also trying to repeal medicare. this is outrageous. the american people do not want the house republicans to dismantle medicare. the affordable care act, mr. speaker, provides dedicated funding for the training of family doctors to graduate medical education programs at teaching health centers. the republicans, while they claim they support doctors in training programs, don't believe in this dedicated funding. this bill not only rescinds the direct funding for these programs, it reduces the authorization by nearly $50

million. now, everyone knows there is a shortage of primary care physicians in this country. why, then, do republicans want to undercut efforts to bring physicians into areas of desperate need? making these funds discretionary will jeopardize the 11 programs currently under way across the program, including one program in my home state of massachusetts. making these funds discretionary does not help our constituents who are struggling to obtain primary care. making this program discretionary will deter other entities from making business decisions necessary to expand residency training, decisions like securing commitments from key stakeholders who agree to train new or additional candidates, hiring new faculty if funding -- if funding -- hiring new faculty with funding over the next few years. finally, claims this this bill saves hundreds of millions of dollars is not true. republicans may claim that this bill will cut nearly $200

million from the deficit, but that's only true if congress provides no funding for this program. c.b.o., the nonpartisan budget ash tore, that republicans frequently ignore, estimates that $184 million will be appropriated over five years, meaning only $11 million will be saved by h.r. 1216. so claims of this credible fiscal austerity are simply not true. now, a second part of this rule is the martial law portion for same-day consideration of the patriot act extension. the republicans feel it necessary to once again jam this bill through this house as soon as the senate is done -- as soon as the senate is done with it. this is no way to debate legislation dealing with our homeland security and basic civil rights and civil liberties. this is an important issue. members need time to be able to understand all the implications of the patriot act. lastly, mr. speaker, let me say just a few words about the f.y.

2012 national defense authorizations act, which we'll begin general debate later today. all members of this house are strongly committed to protecting our national security regardless of party, region or political view. it's been the tradition of the house armed services committee that the staff and member level to work in a bipartisan way to carefully craft the annual defense authorizations bill and i recognize chairman buck mckeon and ranking member adam smith for continuing that collegeality. but given such tradition, it comes as a surprise to see so many provisions in h.r. 1540 that attempt to repudiate an atact several of the president's national security policies. from warehousing low-level detainees for an indeterminate period of time, to the repeal of don't-ask, don't-tell, to hamstringing the implication of the bipartisan supported new start treaty, to the updated -- military force that no longer

references the devastating 9/11 attacks against america but instead gives broad authority to the executive branch to pursue military operations anywhere for any length of time. such changes have all the appearance of a partisan agenda. this afternoon, the rules committee will be reviewing many of the amendments on these and other issues. and i hope they will be made in order so that a broad range of issues and recommendations might be considered and voted upon by this body. now, a number of those amendments will deal with the future of our policy and military operations in afghanistan. as most of my colleagues know, i believe that we need to rethink our tratt gee in afghanistan. it is -- strategy in afghanistan. it is bankrupting our nation. the gentlelady from north carolina talks about the deficit. i will remind her and others that we are borrowing to pay for the war in afghanistan. we are borrowing approximately $8.2 billion a month, that's billion with a b. so we're going to be series --

if we are going to be serious about deficit reduction, if you support the wars then you should pay for them. it has lost 1,503 of our service men and women and gravely wounded thousands of our troops. and right now there is no true end in sight. the death of osama bin laden creates an opportunity for us to re-examine our policy in afghanistan and asks the president exactly how and when he will bring the last troops home to their families and their communities. the death of bin laden provides us with a moment to commend our intelligence and uniformed men and women and also allows us to bring fresh eyes to what kind of defense budget and priorities best fits the needs of our nation and our national security, especially in these difficult economic times. i hope that the rules committee will embrace such a debate, allow a broad range of amendments to be made in order and support a fresh and critical examination of the policies and priorities put

forward in h.r. 1540. with that, mr. speaker, i reserve the balance of my time. the speaker pro tempore: the gentleman from massachusetts reserves. the gentlewoman from north carolina is recognized. ms. foxx: thank you, mr. speaker. and i thank my colleague from massachusetts for bringing up some issues that need to be responded to. first of all, let me say he says that we plan to repeal medicare. it was the democrats who in voting for the health care act that took over health care in this country to the federal government who cut $500 billion from medicare, a half a trillion dollars. republicans have made no recommendations to cut medicare at all. only the democrats have voted to do that, not republicans. republicans want to save medicare, mr. speaker. that is what we are doing. we're recommending that we save

medicare for the future. the democrats are the only ones who want to repeal medicare by cutting that money from it. let me mention a couple other things that my colleagues -- my colleague has spoken about in terms of the underlying bills. in terms of the patriot act, i believe it is the attorney general, the democrat attorney general, eric holder, that recommends that not only the patriot act be renewed but these provisions be made permanent. it is coming from that side of the aisle that the -- they want the patriot act renewed. so their president is pushing for this. in terms of borrowing for the war, mr. speaker, you know, it is the federal government and only the federal government that provides for the national defense of this country. that is why we have a federal government, mr. speaker. it's why we became the united

states. no other branch of government can proride for our national security. every other branch of government, however, can handle health care, can handle education, can handle many things that the federal government has gotten itself into that it has no business being involved in. so if we had to borrow money, we wouldn't be borrowing money if we weren't in these other things. we'd have ample resources to provide for the national defense. but i'd like to point out to my colleague from massachusetts that it was a democratic president who took us into a third war can with no authorization from the congress. and it is not the republicans who are creating this problem. mr. speaker, the second bill made in order under this rule is h.r. 1540, the national defense authorization act. mr. speaker, this weekend we'll

all pause to observe memorial day as we should. as we debate this very important bill, we need to keep in mind this men and women of the armed forces and their families. we also need to keep in mind those who have made the ultimate sacrifice in defense of all of our freedoms, including this process of freely debating our laws and the idea of the role of government. we could not be here today without the sacrifices of those who served in the military and kept us a free people. i hope that's what everyone keeps on their mind this week when they celebrate memorial day. as james madison wrote in the federalist papers, quote, the operations of the federal government will be most extensive and important in times of war and danger, many end quote. our founding fathers had a clear view that the primary and central job of the federal

government was to, quote prorkvide for the commons defense, end quote. providing for the common self-defense a mandate of our constitution. it's not an issue that should divide us in partisan rain cor duh unite us a -- rancor but unite us as a country that provides the mail care -- military with the tools to do their important job. one need not look too far back in history to find words that proe-- remind us of our responsibility to provide for the common defense. president ronald reagan promised to, quote, check and reverse the growth of government but also to maintain sufficient stronte repre-vail if need be, knowing if we do so we'll have the best chance of never having to use that strength. that message, mr. speaker, still holds true today. not only does this bill ensure that our troops are properly equipped, but also provides the men and women of the military

and their families with the resources and support they need, deserve, and have earned. the fiscal year 2012 national defense authorization act takes a detailed approach to ensuring that the investments in our national security are in line with our fiscal priorities an realities. the bill has a clear mandate of fiscal responsibility, transparency, and accountability within the department of defense. it also provides incentives to have competition for every taxpayer dollar associated with funding of defense requirements. the bill addresses a wide range of recent policy changes at the department of defense, including the repeal of don't ask, don't tell, reaffirming the defense of marriage act, which protects one man, one woman marriage, as well as ensure thuring military is properly equipped, trained and staffed for any future threats

to our national security. just as our men and women in uniform stand ready to defend our country, congress must also tackle the fiscal crisis facing our nation. nothing, mr. speaker, is more dangerous to our national security than the crushing debt that our country is in. many of my colleagues have come to the floor warning that the sky was going to fall and armageddon would be upon us if we did not raise the debt ceiling. last week, we hit the debt ceiling an guess what? the sky is still up there and we're paying our bills. history shows that in 1985, 1995, and 2002, congress delayed raising the debt ceiling for months without an armageddon-like economic meltdown. our intent on this side of the aisle is to pay down the debt with fiscally disciplined and responsible budgets that reduce deficit spending. with a system like that in place, there'll be no need to

continue to raise the debt ceiling and create further financial burdens that can cost each american over $40,000. imagine a better american future. imagine what americans can achieve if we're freed from washington's debt burden. on march 16, 2006 a young senator took the floor in the united states senate and said, quote, the fact that we are here today to debate raising america's debt limit is a sign of leadership failure. it is a sign that the u.s. government can't pay its own bills. it's a sign we now depend on ongoing financial assistance from foreign countries to finance our government's reckless fiscal policy. mr. speaker, that senator voted against raising the debt ceiling. and that senator was barack obama. our couldn't president. as far as that statement goes -- our current president. farce that statement goes, i

agree with the president that our dependency on foreign funds is reckless and a danger to our national security. just as dangerous is the failure to achieve energy security. republicans strongly believe that energy security depends on domestic energy production. our friends, the liberal democrats, and president obama have actively blocked and delayed american energy production, destroying jobs, raising energy prices and making the u.s. more reliant on unstable foreign countries for energy. this is hurting american families and small businesses who are vital to creating the new private sector jobs we so desperately need in this time of high unemployment. the liberal proposals fail to create jobs in america but help create jobs overseas for the citizens of foreign nations. we need policies that allow us to take advantage of our natural resources and our innovative culture to develop

new sources of energy and create jobs here at home. to date, the oobama administration has pursued an anti-energy agenda rife with policies that block domestic energy production and destroy jobs. the consequences of this agenda are dire. in the short-term -- in the short-term, it fuels a rise in gas prices and costs for consumers. in the long term, it limits innovation and stifles commick growth and job creation. mr. speaker, we need to approve the rule which we are debating and the underlying bill so that we can stop the funding of abortions and so that we can fund our military. and we need to look at the other policies that are being promoted by our colleagues on the other side of the aisle and in the white house to see that we can become more secure as a

nation and with that, i reserve the balance of my time. the speaker pro tempore: the gentlewoman from north carolina reserves. the gentleman from massachusetts. mr. mcgovern: i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. mcgovern: i feel i need to clarify the record on a couple of things. my friend from north carolina said the republicans want to protect medicarism suggest she read the bill that she voted for. and other republicans voted for. the so-called ryan budget. the way they protect medicare is by destroying it. they turn it into a voucher system. . it means seniors will pay more and get less protection. it is outrageous what they're proposing. more and more americans are reading the bill and are outraged by what they are seeing. democrats and i hope some thoughtful republicans will stand firm and protect medicare. it is the most important, successful, program in our history, along with social security. and efforts to dismantle it, and to put more burden on our

senior citizens for their health care and to -- basically a major giveaway to the insurance companies, is not protecting medicare. and the gentlelady talks about the reckless spending in washington. i will remind all my colleagues that when bill clinton left office, we didn't have a deficit. we were paying down our debt. and there was a detailed article in "the washington post" not long ago explaining how we went from no deficit to a huge deficit. and it includes tax giveaways to the wealthiest people in this country that were not paid for. you know. i find it somewhat sad that one of the first things that were done in terms of addressing economic concerns was to protect the tax cuts for people like donald trump for the -- but then to go in and cut emergency fuel assistance for poor people. and to go after food and nutrition programs and pell grants. that's not the way we should be balancing the budget.

the "washington post" talked about the tax cuts for the wealthy that were not paid for. on top of that, two wars not paid for. i'm against these wars. but if you're for them, you ought to pay for them. that's the way we have done it throughout our history. world war ii, we paid for it. there was a war tax, we had war bonds. the vietnam war was paididididid part by eroding lyndon johnson's great society. paid for. but now we have these wars not paid for. $800 billion a month in afghanistan alone. i hope this is not a partisan agenda when we talk about the war in afghanistan. i'm not here to put the blame on one party or another. i hope we have these amendments on the floor and have some discussion about ways we can bring this war to an end. i think democrats and i know a lot of republicans feel that we should bring this war to an end. in terms of energy policy, i think people are horrified that

we continue to protect taxpayers subsidies to big oil companies while they're gouging us at the gas pump. unbelievable. that we can't have a debate on this floor about taking away these taxpayer subsidies to big oil that are making record profits system of i hope that we will talk a little bit more about that at the end of this debate. at this time, i'd like to yield two minutes to the gentleman from california a former member of the rules committee, ms. matsui. the speaker pro tempore: the gentlewoman is reck hised for two minutes. ms. matsui: thank you, mr. speaker. i thank the gentleman for yielding me time. i rise today in opposition to the rule and the underlying legislation. h.r. 1216 would put the future of primary care work force into question. the affordable care act included critical funding for several grant programs designed to increase the size of the health care work force. and specifically, to increase the number of general practice

and primary care physicians. primary care has long been neglected in our country. and it has been well documented that our country faces a looming shortage of primary care providers. the affordable care act will help train and develop 16,000 new primary care providers. that means 16,000 more primary care doctors to help keep our children and families healthy. the study correlates better health care to better outcomes. if this bill were enacted we would no long ver the pipeline of primary care providers to meet demand and we would continue the status quo which for too many is either forgoing care or seeking care in the emergency room. this perpetuates the onset of chronic conditions such as heart disease, diabetes and

cancer. this is increasing costs and costing lives. i urge my colleagues to reject this rule and to vote down this bill for the future of our physical and fiscal health of our constituents an our country. i yield back the balance of my time. the speaker pro tempore: the gentlewoman yields back her time. the gentleman from massachusetts reserves. the yom from north carolina is recognized. ms. foxx: mr. speaker, i'm going to reserve at this time. the speaker pro tempore: the gentlewoman reserves. the gentleman from massachusetts. mr. mcgovern: i'd like to yield three minutes to the gentleman from ohio, mr. kucinich. the speaker pro tempore: the gentleman is recognized for three minutes. mr. kucinich: thank you very much. to my friend on the other side of the aisle, i want to say that i'll be offering an amendment to the defense authorization bill which would defund the war in libya. the war is unconstitutional.

the president did not come to this congress he went to the u.n. security council, he went to a number of international bodies, didn't come to the united states congress, last week, the president did not observe the war powers act so he's in violation of the statute. the action over in libya has already exceeded the u.n. mandate, it's in violation of the u.n. mandate and violation of international law. what are we doing there? why does anyone think we can afford -- why aren't we trying to find a path to peace so rewe don't spend more money there? these are questions we have to be asking, that's why congress needs to say, we're not going to spend more money there. people are saying it's not the united states, it's nato. "the guardian" in the u.k. did a study where 90% of the cruise missiles are paid fory the

u.s., 60% of the personnel against libya are from the u.s., 50% of aircraft, 50% of ships and they're saying this is a nato operation? come on, we have to recognize what's going on here, which is an expansion of the war power by the executive and it's time we challenge that, and one thing we certainly shouldn't do is to support the amendment offered by my friend, mr. mckeon, that wants to hand over to the president congress' constitutional authority to declare authorized war, substantially altering the delicate balance of power the founding fathers envision the annual re-authorization contains uns predened and dangerous language which gives the president virtually unchecked power to take this country to war and to keep us there, the bill substantially undermines the constitution, the institution that the constitution set up that is congress and sets the american -- the united states on a path to permanent war.

congress has to protect the american people from the overreach of any chief executive, democrat, republican, any chief executive who's enamored with unilateralism, preemption, first strike and the power to prosecute war without constitutional authority or statutory prescriptions. permanent global war isn't the answer. it's not going to increase our mall security. far from ridding the world of terrorism. it will become a terrorist recruitment program. the war in iraq based on lies. yet in iraq we'll spend over $1 trillion. in afghanistan we've spent over half a trillion dollars. we have people out of work here. we have people losing their homes, losing their health care, losing their retirement security. all we hear from the white house we want more war or more authorization for more war. we have to stop that and while stopping that we have to stop this national security state and stop the extension of the

patriot act which is also in this bill. thank you very much, mr. speaker, mr. mcgovern. thank you. bye. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from massachusetts reserves. the gentlewoman from north carolina. ms. foxx: thank you, mr. speaker. i need to point out to my colleague from massachusetts, as i do almost every time we are on the floor together, and i do enjoy being on the floor with him, that he always brings up the fact that we have a surplus when -- we had a surplus when president clinton left office. the reason we had a surplus had nothing to do with president clinton. it had all to do with the fact that we had republicans in charge of the congress. and just before the democrats took over the congress in 2007, as my colleague from massachusetts so well knows, the c.b.o. projected that there would be a surplus in the united states. however, the democrats took over in january, 2007, and

immediately rebegan running deficits because of their profligate spending. i'd also like to point out to my colleague from massachusetts, as he so well knows, that the democrats are in control of the senate, held a vote last week on whether or not to change the tax code in order to disallow incentives that are given to the oil companies for securing oil for this country. and as he knows, again, it's controlled by the democrats, it was turned down by the senate. so i'd like to point out to him that republicans are not responsible for the deficit, and republicans not responsible for denying legal tax exemptions to oil companies. it is the democrats who are responsible for that. i'll allow my colleague to make comments, but i won't allow him to rewrite history.

mr. speaker, we have great political unrest in the middle east, and growing demand from china threatens our ability to secure long-term reserves of oil from foreign entities. that's why i must pursue an alternative energy policy in this country. one that puts to use our domestic supplies and technologies. republicans are going to continue to pursue an all-of-the-above energy plan aimed at increasing our domestic production to bring down energy prices while creating jobs here at home and ending our dependence on foreign sources of oil. what it means, mr. speaker, is we believe in conservation, we believe in alternatives, but we also believe in using the resources that the good lord behave us here in this country which are being denied to the american people by our colleagues on the other side of the aisle. mr. speaker, american families

cannot wait any longer for relief at the pump. american families can't wait any longer for increased jobs. as we head back to our districts for the memorial day holiday, it's fitting we should all give thanks for those that's given their lives in defense of the freedom we very much cherish. every day courageous young men and women from all over america volunteer to serve our country in the military. they do not join for the great pay, luxurious lifestyle and swanky accommodations. they join the military and serve with dignity and honor because they love this country and they love what we stand for. they serve a much higher purpose than themselves. what our troops provide for us can be summarized in one word -- america. we need now to all come together as supporters of the men and women of the armed forces and their families as proud americans and provide them with the tools and

resources that these brave volunteers deserve which is why my colleagues and i all need to vote for the underlying bill, the defense authorization bill, but we also need to vote for the rule which is going to allow for almost unlimited number of amendments to be offered, mr. speaker, unlike what our colleagues did when they were in charge in the 110th and 111th congress. with that, mr. speaker, i'll reserve the balance of my time. the speaker pro tempore: the gentlewoman from north carolina reserves. the gentleman from massachusetts is recognized. mr. mcgovern: i yield myself such time as i may consume. the speaker pro tempore: without objection. mr. mcgovern: the late great patrick moynihan said you are entitled to your own opinions but not your own facts. the fact is, mr. speaker, when this record surplus was turned into a record deficit, i would remind the gentlelady that the republicans controlled the house, they controlled the senate and they controlled the white house. and that is when we passed

these tax cuts for the richest people in the world, and they were not paid for and that is when we embarked on two wars we did not pay for. i guess the gentlelady wants to continue these wars. i want to end them. you need to pay for them. it's not fair to the men and women who are sacrificing their lives and the men and women who are in harm's way and their families to just accumulate all this debt, you know, and pass it on to them and their children and their grandchildren. we ought -- if we're going to go to war, we ought to take some responsibility. and finally, the issue of the oil -- the taxpayer subsidies for oil companies. we have not had a debate on this house floor or debate on this house floor. i don't care what the senate did or did not do. i'm not a member of the united states senate. i'm a member of the united states house of representatives. and under this new and open process that we were promised, by the way, not a single open rule yet, not a single open rule, but under this new and

open process, we can't bring an amendment to the floor to be able to debate this issue. so i would respectfully suggest that maybe, you know, my colleague from north carolina and the rules committee will once in a while vote for an open rule so we can bring some of these things to the floor. at this time i yield three minutes to the gentleman from colorado, mr. polis. the speaker pro tempore: the gentleman from colorado is recognized for three minutes. mr. polis: mr. speaker, i rise in opposition to the rule and the underlying bill in its current form. by delaying the repeal of don't-ask, don't-tell this bill will weaken our armed forces and further confuse an issue that our country and our military have simply moved passed. this bill in its current form says to gay and lesbian service members, you're welcome to fight and die for our country as long as you live in secret. mr. speaker, don't-ask, don't-tell tells members of our brave military to be in constant fear for being --

their personal lives has no bearing on their service. it's a law that hinders our military's effectiveness. it's a law that congress has already voted to repeal. it's a law, frankly, that's un-american. yet, here we are again considering a bill that would continue to codify discrimination. we should not go back to those dark days and we will not go back. in april, the service chiefs reported to the house armed services committee the process of certifying the end of don't-ask, don't-tell is moving forward in response to service members has been overwhelmingly positive. the staff director of the joint chiefs said the process is moving ahead without incident. the undersecretary of personnel for readiness said the training programs for the repeal are going along. they support it moving forward as well as the vast majority of the american people. 72% support the repeal of don't-ask, don't-tell. don't-ask, don't-tell hurts

military readiness and national security every day. to date, over 13,000 service members who have been trained at taxpayer expense have been forced out military under this policy. it's hard to believe that they will somehow make us more effective or combat ready. the commander in chief, the secretary of defense, who i might add was originally pointed by president bush, as well as the joint chiefs of staff, support repeal. mr. speaker, it's time for don't-ask, don't-tell to move from the law books to the dust bins of history. its only value is a lesson to future generations that our nation is stronger when we welcome all members of the american family and weaker when we divide and discriminate. i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from massachusetts reserves. the gentlewoman from north carolina is recognized. ms. foxx: mr. speaker, i will reserve because i am ready to close, but i believe the gentleman from massachusetts has additional speakers, and

i'll reserve. thank you. the speaker pro tempore: the gentlewoman reserves. the gentleman from massachusetts. mr. mcgovern: mr. speaker, i'd like to yield two minutes to the gentleman from new york, mr. bishop. the speaker pro tempore: the gentleman from new york is recognized for two minutes. mr. bishop: thank you, mr. speaker. i rise in opposition to the rule and support the gentleman's motion to move the previous question. this motion demonstrates we are serious about creating jobs, growing the economy and lowering gas prices. my republican colleagues are instead relit gaiting an issue that was debated over the past year. as i traveled all across my district last week, not one of my constituents said the health reform should be altered to fund residency programs. rather, my constituents want to hear what congress is doing now to lower the price of a gallon of gas. they want to know how we are responding to turmoil in the middle east and speculation by wall street which are causing this price spike. in the easternmost point of my

district, regular unleaded gas, $4.89 a gallon yesterday. recreational and commercial fishermen, small businesses and the whole local economy are all being squeezed by gas prices. my constituents want to know what congress is doing in response and how we plan to create jobs and expand our economy. but since the new republican majority took over this year, we haven't debated a single jobs initiative or anyone meaningful proposal to reduce the price of gas for consumers. not one. in the 140 days suns the 112th congress began we have debated zero job bills and only a handful of bills related to energy. most of which focus on reducing the price of gas 10 years from now, maybe. mr. speaker, i urge my colleagues to vote against the previous question so we can focus on our priorities, reducing gas prices, creating jobs and helping middle-class americans keep up in today's economy. i yield back. the speaker pro tempore: the gentleman from new york yields back.

the gentleman from massachusetts reserves. the gentlewoman from north carolina. ms. foxx: is the gentleman from massachusetts prepared to close? mr. mcgovern: i'm the final speaker. mr. speaker, may i ask how much time i have left? the speaker pro tempore: the gentleman from massachusetts has 2 1/2 minutes. mr. mcgovern: ok. thank you. ms. foxx: and how much time do i have left, mr. speaker? the speaker pro tempore: the gentlewoman from north carolina has nine minutes. mr. mcgovern: mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. mcgovern: mr. speaker, i want to support the efforts of my colleague from new york, mr. bishop. let me say, the american people are sending a clear message to republicans, show us the jobs. after 140 days of the new g.o.p. majority they keep pursuing their agenda that destroys jobs and stalls our economic growth. this week is no different. and today republicans are only making matters worse, voting to kill graduate medical education in qualified teaching health care centers. the previous question, as mr.

bishop referred to it, is based on h.r. 964, the federal price gouging prevention act, and it takes a stand for working families facing tough times and paying so much more at the pump. during international oil crisis, as declared by the president, this legislation makes it illegal to sell gasoline at excessive prices and prevents big oil from taking advantage of consumers and engaging in price gouging. the cost of a barrel of oil and a gallon of gas have already reached their highest levels in years with no end in sight. and america's middle class is paying the price. . republicans must join with democrats to ease the burden on our middle class. we must work together to create jobs, strengthen the middle class, and responsibly reduce the deficit. to help consumers at the pump and provide relief to small businesses and families struggling with high gas prices, this legislation expands the

authority of the president to release oil from the strategic petroleum reserve, to combat market manipulation and bring down the price and make it a federal crime to sell gasoline at excessive prices. the legislation also protects taxpayers, holds big oil accountable, repeals the largest tax breaks for the five -- big five oil companies, and ensures that oil companies pay billions of dollars owed to taxpayers for drilling on public lands. this is part of our multifaceted effort to lower the price of gas now. bring relief to consumers and taxpayers, strengthen our energy security, and reduce our dependence on foreign oil, and hold big oil accountable. republicans drill only, oil above all plan is really a boon for big oil and does nothing to reduce the pain at the pump for america's middle class families who are facing these enormous prices each and every day. republicans are simply returning

to the bush policies for big oil, continuing to pursue drill only policies with fewer safeguards and no accountability that has us sending $1 billion a day overseas for foreign oil. mr. speaker, if we defeat the previous question, i will offer an amendment to the rule to provide that immediately after the house adopts this rule, it will bring up h.r. 964, the federal price gouging prevent act -- prevention act introduced by tim bishop of new york. i ask unanimous consent to insert the text of the amendment in the record along with extraneous materials immediately prior to the vote on the previous question. the speaker pro tempore: without objection, so ordered. mr. mcgovern: mr. speaker, i urge my colleagues to vote no and defeat the previous question so we can debate and pass a bill that actually addresses the price of gas. i have tried, mr. speaker, on numerous times in the rules committee to bring responsible amendments to the floor that would get at this issue of taxpayer subsidies to big oil companies. and every single time my

republican friends have voted no. every time there's been an opportunity to address this issue, they have voted no. i urge my colleagues to vote no and defeat the previous question and urge a no vote on the rule. i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the gentlewoman from north carolina is recognized. ms. foxx: thank you, mr. speaker. i want to bring our attention again to the upcoming memorial day because we are going to be honoring the fallen and praise their service and sacrifice. we need to remember the families of the fallen and reassure them that their sacrifice and the lives of their heroes was not lost in vain. we are also very proud of our troops who are currently serving and we want to make sure that they get that message from us in this body, mr. speaker. i'd also like to point out to my

colleague from massachusetts that the unemployment rate was 5% when they took over the congress, or approximately 5% when they took over the congress in january, 2007. under their control and president obama's it reached 10%. and has stayed at around 9% since they -- while they were in control. so i want again make it clear that we have worked hard to make the economy work again and we are going to continue that. mr. speaker, although i have said it also before, it bears repeating. americans are sick and tired of reckless government spending creating only government jobs which hurts our overall economy and creates the high unemployment. americans are deeply concerned about the outrageous level of federal debt.

our constituents are concerned about the piece of our economy that is now owned by other countries like china. they are very concerned about the fact that so much of our tax dollars, the tax dollars they pay go toward paying interest on the debt instead of using it for the country's immediate needs. mr. speaker, that's why americans are looking at the new house republican majority for real answers to their concerns. after four years of complete lack of leadership in congress, we have rolled up under the democrats, we have rolled up our sleeves and are making the tough decisions to get our economy and fiscal house back in shape. the federal government lrned to live within its means and be accountable for how it spends taxpayer money. house republicans are continuing to fulfill our pledge to america and keep the promises we made to the american people before the election last november.

i urge my colleagues to vote in favor of congressional oversight and against special interest by voting in favor of this rule and the underlying bills. i yield back the balance of my time. i move the previous question on the resolution. the speaker pro tempore: all time having 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. the gentleman from massachusetts. mr. mcgovern: i ask for the yeas and nays. the speaker pro tempore: the yeas and nays are requested. those favoring a vote by 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 9 of rule 20, the chair will reduce to five minutes the minimum time for any electronic vote on the question of adopting the resolution. this is a 15-minute vote. [captioning made possible by the national captioning institute, inc., in cooperation with the

united states house of representatives. any use of the closed-captioned coverage of the house proceedings for political or commercial purposes is expressly prohibited by the u.s. house of representatives.]

the speaker pro tempore: on this vote the yeas are 233. the nays are 179. the previous question is ordered. the question is on adoption of the resolution. so many as are in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it. the gentleman from massachusetts. mr. mcgovern: on that i ask a recorded vote. the speaker pro tempore: a recorded vote is requested. those favoring a recorded vote will rise. a sufficient number having arisen, a recorded vote is ordered. members will record their votes by electronic device. this is a five-minute vote. [captioning made possible by the national captioning institute, inc., in cooperation with the united states house of representatives. any use of the closed-captioned coverage of the house proceedings for political or commercial purposes is expressly prohibited by the u.s. house of representatives.]

the speaker pro tempore: on this vote the yeas are 238. the nays are 181. the resolution is adopted. without objection, the motion to reconsider is laid upon the table.

the speaker pro tempore: for what purpose does the gentleman from kentucky rise? the house will be in order. for what purpose does the gentleman from kentucky rise? >> mr. speaker, i ask unanimous consent that all members may have five legislative days to revise and extend their remarks on the legislation and to insert extraneous material on the bill.

the speaker pro tempore: without objection, so ordered. mr. -- pursuant to house resolution 269 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. 1216. the chair appoints the gentleman from texas, mr. poe, 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 consideration of h.r. 1216, which the clerk will report by title. the clerk: a bill to amend the public health service act to convert funding for graduate

medical education and qualified teaching health centers from direct appropriations to an authorization of appropriations. the chair: pursuant to the rule, the bill is considered as read the first time. the gentleman from kentucky, mr. guthrie, and the gentleman from texas, mr. green, will each control 30 minutes. the chair recognizes the gentleman from kentucky. mr. guthrie: thank you, mr. chairman. i yield myself such time as i may consume. the chair: the gentleman is recognized. mr. guthrie: i rise today in support of h.r. 1216, the health care bill that spent over $1 trillion last year and empowered federal bureaucrats more than it did the american people. as a member of the energy and commerce committee, i have been working on legislation that takes steps -- the chair: the gentleman will suspend. the house will come to order. the gentleman from kentucky is recognized. mr. guthrie: thank you, mr. chairman. take steps to peal back a few of the many mandatory programs

instituted in the health care law and limit the federal government's unprecedented power. section 5508 of the health care law, authorizes the health and human services secretary to work teaching health centers and appropriates $230 million from 2011 to 2015. h.r. 1216 amends the public health service act to convert funding for graduate medical education and qualified teaching health centers from direct appropriations to an authorization of appropriations. this bill is not about the merits of graduate medical education or teaching health centers, everyone agrees there are strong needs for more primary care physicians in our health system. but picking and choosing one program over another to receive automatic funding is irresponsible. making these programs mandatory spending is unfair to all of the other health care programs that have to be -- compete every year to continue to receive funds. for example, as h.h.s. secretary

said during her testimony before the house energy and commerce committee earlier this year, the president's f.y. 2012 budget eliminates graduate medical education for children's hospitals. while children's hospitals must go through the regular appropriations process to fight for funding, teaching health centers will receive an automatic appropriation. we are a $14.3 trillion in debt and our deficit for this year will approach $1.5 trillion. congress is making difficult decision abouts which programs to fund and which to reduce. . we must prioritize and i find it unfair that some programs are unshielded and do not have to have merit to continue their funding. i urge my colleagues to vote yes and reserve the balance of my time. the chair: the gentleman reserves. the house will come to order. the committee will come to order. the committee will come to order.

the gentleman from texas is recognized. mr. green: thank you, mr. speaker. i yield back the balance of my time. the chair: without objection. mr. green: i rise not in support of h.r. 1216. the affordable care act authorized a five-year program to support a credited primary care residency training operated by community-based entities including community-based health centers. this training takes base in settings such as community health centers. research shows that c.h.c. trained physicians, for example, are twice as likely as their nonc.h.c. counterparts to work in underserved areas. it makes sure that training takes place, which is mandatory funding for programs help do. it will help strengthen the primary care work force in

underserved areas, specifically those that are hard to russ taint work. it includes peed at ricks, gynecology, psychiatry, geriatrics. it's hypocritical for i or the republican colleagues to take away this funding. they continue to argue there is not enough physicians to provide care to people who need them in primary care services. this program is designed to help address this very program, but they keep trying to have it both ways in the health reform debate. this is just another example. today, the majority is going to say they have an obligation to share this program is subject to appropriations process. due to the need for transparency in our spending process and current budget process. let me remind the majority we are not the only party who's directed mandatory funding for programs.

the majority must have supported autopilot spending as representative foxx described it, the teaching health program when they passed a modernization act of 2003 which required mandatory funding for transitional programs. i suppose at that time the majority certainly felt they knew better than the appropriators that the m.m.a. was a worthy program and deserved mandatory program. even though they passed it under the cover of -- with a lot of arm twisting. i can't understand the opposition, particularly from my republican colleagues, they have repeatedly and inaccurately complained we do not do enough to prohote health work expansions and now they are going to cut are the health work expansion. it will make it challenging for these 11 programs that have already made the decision to participate in consultation with key stakeholders like teaching hospitals and their boards and based on that continuing funding will be available. to move this to discretionary

funding will deter others to expand residency training since funding over the next few years could be subject to the annual appropriations fight. this will be a another political stunt by the republican to defund health reform. this is playing games to i can -- several weeks ago they couldn't stop talking about medicaid, will be greatly improve with the ryan budget because it provides states with block grants under their medicare program. how great would it be to give seniors vouchers to purchase health insurance? and this week we're busy taking away funds to make sure we train physicians to make sure that all americans have access to affordable care. once again, the republican majority is wrong in this. i reserve the balance of my time. the chair: the gentleman reserves the balance of his time. the gentleman from kentucky. mr. guthrie: i yield two minutes to the gentleman from pennsylvania, the chairman of

the subcommittee. the chair: the gentleman from pennsylvania is recognized for two minutes. mr. pitts: i'd like to thank the gentleman from kentucky for his leadership on this issue. it authorizes the secretary to award grants to teaching health centers to establish newly accredited or expanded primary care residency programs. the new health care law, hi packa, provides a mandatory appropriation of $230 million for this purpose for the period from f.y. 2011 through f.y. 2015. you may recall that in the president's fiscal year 2012 budget he eliminated funding for training at children's hospitals. because of this i and the ranking member of the health subcommittee, the gentleman from new jersey, mr. pallone, have introduced h.r. 1852, a bill to re-authorize the children's hospitals graduate

medical education program for an additional five years at the current funding levels. while the administration couldn't find money in its budget for training at children's hospitals, hipacca had an additional $230 million for other health centers without any input or approval required by congress. if it did this with a number of funds, appropriations. the bill before us today, h.r. 1216, simply converts the mandatory appropriations to an authorization subject to annual appropriations process. just like the children's hospital g.m.e. program, making it discretionary. passage of the bill would also save $215 million over five years. i urge support of the bill and i yield back the balance of my time. the chair: the gentleman from pennsylvania yields back his time. the gentleman from kentucky

reserves. the gentleman from texas is recognized. mr. green: mr. speaker, i yield two minutes to my colleague from the energy and commerce committee, congresswoman capps. the chair: the gentlewoman from is recognized for two minutes. mrs. capps: thank you, mr. speaker. i thank my colleague for yielding, and i rise in strong opposition to this reckless bill. i cannot count the number of times members on both sides of this aisle have decried shortages in the primary care work force of our communities and working often in bipartisan manner to develop ways to increase the primary care ranks. and yet today, the next victim in the republican obsession with repealing the affordable care act is a program that doesn't deal with these shortages. it increases our primary care physician ranks and trains them with special expertise in serving the community. the bill before us would defund this program, taking many qualified americans out of the primary care work force before they even have an opportunity to join it. moreover, cutting these training programs would affect already existing jobs at the 11

community-based entities that have already extended their programs to train these new doctors. take i way this funding would force possible layoffs and would have a chilling effect on other sites developing this type of program. yes, it is paid for under mandatory funding but that's not unheard of or even unusual. the graduate medical education program which has had measured success in strengthening our health care work force is a mandatory spending program. the program the republicans are trying to cut today is simply a complement to this g.m.e. program. focused on community-based care and prevention. the choice on h.r. 1216 is clear. if you believe we do note have a jobs -- not have a jobs problem and we'll have all the doctors we need, then go ahead and vote for this bill. if you think we need to create jobs and we need more primary care providers, you must vote against h.r. 1216 and protect this very important program.

we can't have it both ways. i urge a no vote and i yield back. the chair: the gentlewoman from california yields back. the gentleman from texas reserves. the gentleman from kentucky is recognized. mr. guthrie: i yield four minutes to my friend from tennessee, representative blackburn. the chair: the gentlewoman from tennessee is recognized for four minutes. mrs. blackburn: and i thank the chairman for the time. i thank the gentleman from kentucky for his leadership on this bill. you know, mr. chairman, it's so interesting to me, we had a 2,7 hundred-page health care bill that basically was a government takeover of health care. what we have heard from so many people in this country is gosh, i wish somebody would have read that bill before they passed it and the former speaker said we need to pass the bill and then we can read it and find out what's in it. one of the things that many of the people did not like that was in that bill was was many

of the mandatory provisions put in place, programs that had been on the books for years that all of a sudden became mandatory. and the confusing thing, mr. chairman, is there didn't seem to be any consistency. as the subcommittee chairman who spoke before me had said, mr. pitts had said, you know, you don't tend to -- children's hospitals in the same way, you don't tend to nurses in the same way. there is this discretionary for teaching hospitals, a total of $230 million million, over $40 million a year. now, it doesn't matter if you need the money or not, it doesn't matter where you're going to use it or not. the money is going to be appropriated. it's put on autopilot. doesn't matter what we say is going to happen with the government if we need are reduce it. they're going to get that

money. that's why this bill is so important. you'll notice, mr. chairman, that 2,700-page bill, we're able to delete $230 million of that appropriation, mandatory appropriation with the bill that basically is about two pages long. and what we do in this two pages is responsibly address what the american people want to sues us address. they know that the federal mandates are costing private sector jobs. they know that the federal government coming in and taking over health care is causing private sector health care jobs. indeed, we have study after study that is saying we have already lost over a million jobs. it seems like every time we turn around, whether it is our health care delivery system, whether it is our hospitals, whether it is our physicians' offices, we're hearing about the loss of jobs to health care

providers and in the health care sector because of the passage of obamacare, as many people in our country refer to the bill. one of the reasons we have to go about repealing these slush funds, mr. chairman, is because we simply can't afford this. every second of every day, every single second of every single day we are borrowing $40,000. we are bore -- broing 41 cents of every -- borrowing 41 cents of every dollar we spend. this government is so overspent. we are spending money we don't have for programs that our constituents don't want, and instead of eliminating what we are saying is, look, let's eliminate a mandatory program and turn it back to what it was

for years, discretionary, so that members of this body bring their discretion to bear on the issues of the day and bring the opinions of their constituents to bear on how this chamber spends the taxpayers' money. mr. chairman, it is not federal money. it is the taxpayers' money. this government is jore spent. we cannot afford -- this government is overspent. we cannot afford these federal mandates. with that i yield back my time. the chair: the gentlewoman's time has expired. the gentleman from kentucky reserves. the gentleman from texas is recognized. mr. green: i gladly yield to the ranking member of the full energy and commerce committee, congressman waxman. mr. waxman: mr. chairman. the chair: the gentleman will suspend. how much time do you yield?

mr. green: three minutes. the chair: the gentleman is recognized for three minutes. mr. waxman: mr. chairman, there was so much misinformation given out by the previous speaker that it's hard to know where to start. the republicans have said they don't like the affordable care act, but what do they have to replace it with? they say they're going to repeal it and replace it. what are they going to do about the uninsured in this country, about the high cost of health care, about the people who can't even buy insurance even if they have the money because they have pre-existing medical conditions? we have no proposal from the republicans except in their budget they wanted to take medicare away from future seniors by making it a block grant, and they wanted to cut the medicaid program which cuts a big hole in the safety net for the poor to get their health care needs which means people in nursing homes would be dumped out of those nursing homes.

but the bill before us now is to stop the program that would train primary care physicians. does anybody disagree that the notion that we need more primary care physicians? evidently the republicans do because as we heard from the last speaker she wants to make it an appropriated program, not a mandatory spending program. well, spending in medicare and medicaid since 1965. training physicians should be assured with funding we can rely on. we can't train a doctor in just one year. doctors need a number of years. they're going to be assured of their continuation in medical schools. that's why we've had assured

funding through medicare and me cade and in the affordable care act, the purpose was to train physicians for primary care in community settings. that's what the republicans want to repeal and if they can afford it from one year to the next, they'll put in funds, but if they can't because they want to give more tax breaks to the wealthy, we won't be able to afford it. with all the costs to go to medical school, we ought to assure spending for primary care doctors. i you remember my colleagues to oppose this bill. it's incomprehensible to me why we have it on the house floor. it's another effort the republicans have been putting up to chip away at health care reforl. they want to repeal it, they want to chip away at it, they want to know, are they going

going to leave americans on their own without the ability to buy health insurance? are they going to tell the elderly on their own? the chair: the gentleman's time has expired. the gentleman from texas reserves, the gentleman from kentucky is recognized. >> i yield myself such time as i may consume. the chair: the gentleman is recognized. mr. guthrie: there were a number of amendments vote on, block grants, several governors have come to washington and talked about block granting medicaid to give them the opportunity to not just deal with medicaid in their state bus with the other parts of their budget. in kentucky, i used to be a member of the state legislature, as medicaid has continued to consume more of the state's budget, it's harder to fund higher education, tuition costs going up because

of the pie of medicaid going forward. we passed medical liability reform which saves the country $54 billion. we're going to have a bill tomorrow to purchase health insurance across state lines to make health insurance more affordable instead of more expensive on those who spend money out of their own pocket. one thing about relying on funding for one year, we do appropriations for everything from defense to other things on an annual basis and i will tell you, there are not people turning down federal money because you're only appropriating it for one year and we don't want to commit to a long-term program. if you buy that argument, look at what's in the bill. all we're saying is we want the teaching health centers to be treated equally to other parts of the bill. the argument is, if you don't have the pam, you won't have

people participating, it means that pediatric education and training, nurse retention, 5309 section, family nurse practitioner training, ep deemology, laboratory capacity grants, research and treatment for pain care management, tomorrow's pediatric health care work force, the argument that, obviously the argument that was made was if we don't have the teaching hell centers oen an automatic five-year appropriation, people aren't fwing to participate in the pam and that has to apply to thee directly. i guarantee you, i'd be willing to say that people will be applying for these programs as this moves forward. i reserve my time. no further speakers. i reserve my time. the chair: the gentleman from kentucky reserves. the gentleman from texas is

recognized. >> i yield two minutes to a classmate and vice chair of our democratic caucus. the chair: the gentleman is recognized for two minutes. >> to put everything in perspective, we're told that today we can foresee a shortage of some 40,000 primary care physicians in this country in less than 10 years. within another five years that shortage will grow to about 42,000 to 46,000 primary care physicians. mr. becerra: gramming watt medical education funds, does something very simple. it says to some of these clinics, some of these health care poviders that if you guarantee you'll make graduate medical training available to our future drrks we will

guarantee there will be money behind that training so that will be a consistency so that medical student can finish training. we just heard that this money that's available to these health care providers, these clinics, should no longer be guaranteed so the question you have to ask, if you want to become a physician and you're going to medical training an certainly the question you have to ask if you're one of these clinics throughout the entire country where you want to train somebody to a family medical trrks an -- a pediatrician, an on ste se trigs/gynecologist, someone who specializes in jerntology. you have to ask yourself, if i want to train someone but don't have the funds, how can i guarantee i'll be there to pay for the education to pay them for the work they're going to be doing? you can't. that's why g.m.e. is so

important. we were just told this is a slush fund pot of money. furthest thing from the truth. we're told that the -- the real truth when we heard a speaker on the republican say, we're going to delete this money. that's what's going to happen. if you don't guarantee it, it's gone. we have to make sure we can train the next generation of medical leaders and i urge my colleagues to vote against this legislation. the chair: the gentleman's time has expired. the gentleman from texas reserves. the gentleman from kentucky is recognized. mr. guthrie: i yield myself one minute. the chair: the gentleman is recognized. mr. guthrie: the merits of training in pediatrics and public dentistry, i agree the merits are there. if you do it in a public health center you guarantee funding for five years. if you demoit a children's hospital then you're subject to an wrule appropriation. someone came before our

committee to say we need this provision because we need more nurses i agree with that, however this provision doesn't cover nurses. if you're going through a nurse to training program, it's authorized in the bill and have an annual appropriation. i'm saying we should treat hospitals and teaching hospitals exactly the same and not give one an advantage. the chair: the gentleman is recognized. >> bill glad to co-sponsor the bill to make it mander to funding for children's hospitals. i think if health care is a priority we ought to do that. the chair: the gentleman from kentucky is recognized. mr. guthrie: i reserve my time. the chair: the gentleman continues to reserve. the -- the gentleman from texas. mr. green: how much time is available on each side? the chair: the gentleman from

texas has 19 1/4 minutes. the gentleman from kentucky has 18 1/2 minutes. mr. green: i have no further speakers. i yield myself such time as i may consume. the chair: the gentleman from texas is recognized. mr. green: when congress dealt with the affordable care act last year and the year before, our subcommittee on energy and commerce spent exhaustive hearings, late-night hearings, we had markups overnight, we knew what we were doing. we knew we were going to make a priority on providing primary care to our country. that's why it's mandatory spending. i would assume in 2003 when we passed the provision for the prescription drug act for medicare, my republican colleagues did the same thing at that time in a majority. they wanted to make sure that was mandatory spending and here we are today tiing to take away mandatory spending from trying to provide primary care

physicians in community-based settings. a great example of this in our own district, i know the speaker they can chairman knows this, we have a community-based health cent for the denver harbor in east harris county. they have had a partnership with baylor college of medicine for a number of years. they have been able to provide residencies to come out to a nonwealthy area of town so those doctors can learn they can make a living severning folks that are in the wealthy. that's what this is all about. and we found out that statistics show if they do their residency through a community-based health center they will -- they are more likely to come back an serve those communities thatst why it needs to be mandatory spending, mr. speaker. i reserve the balance of my time. the chair: the gentleman reserves. the gentleman from kentucky is recognized. mr. guthrie: i have no further speakers and am prepared to close. i'm sorry, mr. speaker, i do have a speaker. i'd like to yield to the

gentleman from california, mr. bilbray. the chair: the gentleman is recognized. for how much time? how much time does the -- mr. guthrie: i yield two minutes to the gentleman from california. the chair: the gentleman is recognized for two minutes. mr. bilbray: i wasn't planning on addressing this item but i heard so many of anymy colleagues talk about the crisis of providing the doctors who are going to be essential for health care. finally we're talking about health care, not health care insurance. how but as somebody who spent 10 years supervising the safety net for a community of three million in san diego county, i wish my colleagues on the other side, when they were worried about pediatricians and primary health care people would understand, you want to protect those. let's talk about tort reform, especially for pediatricians. this is a constant, bearing

down. when you're asking young people to get an education to be a primary care provider, especially a pediatrician, explain to them why somebody on public assistance has more right to sue their physician than those men an women in uniform. there's no way we should be sitting up here saying we want the next generation to get into health care unless we're willing to tell our feppeds the trial lawyers that we're going to take the physicians off the counter. we're not going to allow lawsuits to be part of theover head driving people out of the health care business. i want to say to both sides, if you want to make sure there are future doctors, let's have the bravely ry to stand up today to do something about the tort those future doctors are looking at before they go into school. i yield back. the chair: the gentleman from texas is recognized. mr. green: i yield myself such time as may consume. the state of florida and state

of texas have medical malpractice reform, that's not what this bill is about. this is about training primary care physicians to be able to serve everyone. i want them to serve the military, i want them to serve our veterans. i have a v.r. houston -- hospital in houston in cooperation with the baylor college of medicine for a residency program. i want them to do that in their clinics an for community-based health center. statistics show us if they have that example, those folks will come back. they may go back to a military clinic or to a community health center or may open up a clinic in ap area that's not the -- in the wealthiest part of town. if you put a priority on making sure our constituents can go see a doctor, i can't imagine repealing -- voting for this pill. i reserve the balance of my time. the chair: the gentleman kentucky is recognized.

mr. guthrie: i yield two minutes to the gentleman from california. the chair: the gentleman is recognized. >> i wish the wrelt from texas would understand that when a physician or a student is planning on getting into a field, they not only look at will the government guarantee that i'll be able to get the tuition, but they're looking at what field am i moving into? let me just tell you as a fact, in california, even with our tort reform, somebody who wants to volunteer in medicaid, volunteer, has to follow an $80,000 or $90,000 insurance policy, rust for volunteering. when you -- when you talk about the educational side that it's essential we encourage people to get in this field, my point is you cannot talk about the educational when you ignore the environment you're asking them to go into and the fact is, what parent would ask somebody

to go into the field and be a physician with all the education and expenses when they can tell their children to be a lawyer and sue those physicians for every cent they've been able to earn. that's where we've got to talk to both of these together. you cant say, we want the essential services but not be willing to get the lawyers off the back of the doctors to provide those essential services. >> again, this is not a medical malpractice bill, but i'd be glad to offer you to be a co-sponsor, we sent a bill twice that would allow volunteers to go into community health centers and be covered urn the federal tort reform actful i've been a lead spon or of this when democrats are in control, ific do it urn this bill, i would do it but this came out of your conference that you want to repeal mandatory spending to try and train primary care doctors to serve in primary care clinics or whatever.

i want them to go into -- mr. -- >> reclaiming my time, the fact is, you are holding these physicians, they're being held with a liability that is inappropriate, way over the head -- mr. fwuth re: i yield another minute. the chair: the gentleman from california is recognized for one additional minute. >> those who want to stand up and say we'll spend federal funds to create an environment to provide health care but not be willing to say not just the fact that we find special tort coverage and i know the jell from texas knows, i was at a county level providing those services, we have a federal program to protect those in community clipics but we're not just talking about the little bit of protection we get with our federal protection. we're talking about the whole tort exposure needs to be considered. fupt to have the medical -- moral high ground on access, you have to take on the trial lawyers that say, physicians are going to be held harmless from your lawsuits.

we're going to find a reason to encourage young people to go to school not just by providing federal subsidies to their tuition but also telling them once you get your degree you'll be able to go into a field where you'll be able to practice your art of medicine without having somebody who has never had to make a life and death decision trag you before a judge and jury and attack you for your decisions. the chair: the gentleman's time has expired. the gentleman from texas. mr. green: reserve -- we have h.r. 5 that the majority has to federalize medical malpractice insurance in our country. some states have taken care of it. texas did it with a constitutional amendment. we may do that with h.r. 5. i yield to my colleague. congressman tonko.

the chair: the gentleman from new york is recognized for two minutes. mr. tonko: this legislation guts funding for teaching health centers across the country. it's our residency program for our health care physicians, providing community-based training for physicians that will work in rural or underserved areas. my amendment will find out how many health care physicians we will lose if the republicans cut training centers across the country. the american people can see how drastically these cuts will eliminate jobs and cut the affordable health options. i'm interested to know, mr. chair, if some of our colleagues are aware if h.r. 1216 is adopted there will be fewer health care physicians in hair communities. this -- in their communities. these 23 individuals are being trained to provide basic health care for constituents in the

greater scranton area. if my republican colleague from the scranton area joins the republican leadership in eliminating this program his community will lose training for new 23 new primary care physicians. that's 23 jobs, jobs that they support and 23 individuals who help serve constituents with their health care needs. again, mr. chair, my amendment is a matter of effective oversight. it asks we find out from a nonpartisan source exactly how many primary care physicians we will lose if the republican leadership moves forward to cut teaching health centers across the country. with that, mr. chair, i thank you and yield back. the chair: the gentleman yields back. the gentleman from texas reserves. the gentleman from kentucky is recognized. mr. guthrie: thank you, mr. chair. chairman, i yield myself such time as i may consume. the chair: the gentleman is recognized. mr. guthrie: i just want to point out, as we went through what we're talking about doing is graduate medical education in teaching health centers will be identical to the graduate medical education in hospitals

and children's hospital. and i'll remember, i was not on the energy and commerce committee but in the education and labor, we worked on the health care bill. the description we went into the night and went through the bill line by line is absolutely true. we were 24 or 25 hours direct on that and i was not on energy and commerce but they went through the nights as well, mr. chairman. when this bill was passed out of the house, the changes were made in the senate. so working late in the night and going through the bill by little what we're asking or proposing is to treat teaching health centers is the house-passed version -- as the house-passed version of the bill did which is exactly the same as hospitals and children's hospitals. and many of the other nurse training and other things as well. i'll reserve my time. the chair: the gentleman from kentucky reserves. the gentleman from texas is

recognized. mr. green: mr. speaker, i yield myself whatever time i may consume. i have no problem, and think we could have passed it on the suspension calendar that we had legislation that would expand that teaching hospitals and children's hospital but that's not what this legislation does today. it takes away that health we're providing to train more primary care physicians in our country. and that's what this bill does. takes away the mandatory funding. now, there have been examples all through the history of mandatory funding. we realize during the affordable health care act we need more primary care physicians. we need a lot more health care providers. we need more nurses. we need everything. in fact, it's a great job growth but we know we need primary health care providers because we have to have somebody when somebody needs a doctor to go see that primary care. they may need a specialist but they still need to go to that primary care doctor. that's why this mandatory

spending is so important, and that's why this bill is the wrong way to deal with it. and that's why it shouldn't be considered today and i hope everybody would realize if you support health care and primary care physicians you would want that mandatory training so we can't get those -- can get those physicians out in the community where they're really needed and where it's hard. the numbers show if we have a program like this where primary care physicians will go into a community they have a -- will go into that area as a residency program they'll more than likely go to that health care community. that's why it's part of the health care law. we have people that are primary care that were in the emergency rooms. i hope people would go to a doctor for a sign us infection rather than going to the emergency room where the local taxpayers are paying for it. that's why this mandatory spending is so important and

that's why i think it's the wrong way to impand health care will take away primary care spending. that's something that's important in our country. it should be mandatory. i reserve the balance of my time. the chair: the gentleman reserves. the gentleman from kentucky. mr. guthrie: thank you, mr. chairman. i yield myself such time as i may consume. the chair: the gentleman is recognized. mr. guthrie: i just want to point out again, the mandatory spending was not in the house version of the health care bill that was passed. teaching health centers were treated exactly like general peed at rick and primary care physicians are -- pediatric and primary care physicians are in hospitals and children's hospitals and we're saying, we're going back to the way it was established in the affordable care act as it was passed out of the house of representatives. we're talking about primary care physicians as well. i agree we need more primary care physicians. they're training at hospitals

in children's hospitals is internal medicine, all the primary care physician specialties that we know and that's why we're saying, one shouldn't be treated differently than the other. they're important and we should go through the annual appropriations process and present the validity of programs and the appropriations process to determine the level of funding. i reserve the balance of my time. the chair: the gentleman reserves. the gentleman from texas is recognized. mr. green: i'll continue to reserve. i know the gentleman has the right to close. if you consider that closing i'll yield back my time. mr. guthrie: thank you. i have one more speaker coming. so i'll reserve. the chair: the gentleman from texas is recognized. mr. green: well, are you planning on -- to close? mr. guthrie: i have one more speaker? mr. green: is this your closing? mr. guthrie: one more speaker and then i'll close. mr. guthrie: thank you, mr. chairman. i yield four minutes to the

gentleman from georgia. the chair: the gentleman from georgia is recognized for four minutes. mr. gingrey: mr. chairman, thank you. and serum i want to thank the gentleman from kentucky for yielding and apologize for my shortness of breath. as everyone knows, the financial health of this nation is in a very precarious state. unfortunately, it was made worse by the spending decisions and actions of this last congress. today, the federal government borrows 1 cents -- 41 cents for every dollar we spend. we're facing a $14 trillion deficit, the fourth straight year of trillion-dollar deficit. a new post-world war ii record as our share of the economy. the reckless spending of the last congress has only exacerbated this problem. the so-called stimulus bill that didn't stimulate much besides a lot of wasteful spending and obamacare, patient

protection and i think unaffordable care act are two such examples of legislation that spent recklessly. mr. chairman, among the 2,400 pages of obamacare, the last congress created $105 billion in secret slush funds that can be used to advance the political goals of president obama and his administration without oversight, congressional oversight. at a time when our country is facing financial ruin, my concern is, how much damage to our national budget the white house can do with these funding streams? the time for blank checks is over. the time for leadership is now. section 5508 of obamacare provides a $230 million direct appropriation for teaching health centers residency programs. h.r. 1216 would simply convert the direct appropriations into an authorization of appropriations. the legislation allows the

teaching health centers to receive funding through the normal appropriations process with proper congressional oversight. mr. chairman, many members of this congress have supported medical education. i certainly count myself among them. including graduate medical education for children hospitals program. however, in her testimony at the energy and commerce subcommittee this year, h.h.s. sebelius stated that the president's f.y. 2012 budget eliminates children's hospitals graduate education programs because they duplicate the teaching center funds in obamacare. mr. speaker, is this the future of medical education that we want for our children, teaching our medical professions and clinics that might not be equipped to properly train them to handle emergency situations versus in hospitals regarded as centers of excellence like the children's health care center of atlanta in my own home state

of georgia? this is why the appropriations process is so important. we need congressional oversight to help at the side what the priorities of tomorrow should be. this congress, the 112th, is focused on reining in spending and reducing our deficit. we cannot do the job of the american people and make the spending cuts necessary unless the legislative branch has oversight over federal spending. if this is truly the people's house, give back what the last congress gave away, control over the budget. if this body wishes to restore fiscal sanity in this country, i so he no reason why this body shouldn't be voting in a bipartisan manner to prevent a president of spendinging our nation into insolvency. so i ask my colleagues to support h.r. 116. i thank the gentleman from kentucky for his bill and yielding the time, and i yield back the balance.

the chair: the gentleman yields back. the gentleman from kentucky reserves. the gentleman from texas. mr. green: mr. speaker, i yield myself such time as i may consume. let me correct some of the statements that have been made. we have had mandatory hospital training residency programs since 1965, and by taking away direct or mandatory spending for community-based residency programs, it's a direct attack on community-based programs. let me list you the teaching hospital program that's under mandatory -- was part of the affordable care act. i joked on the floor one night my colleague from georgia, i wish they would name it the green care act instead of obamacare because i'm proud of it. it supports the training of individuals who practice in family medicine, internal medicine, pediatrics, internal medicine pediatrics, obstetrics, gynecology,

pediatric dentistry or geriatrics. we are experiencing physician shortages. that's why we need the mandatory pentagon. it does cover children. now, we do have mandatory spending for hospital training, again, since 1965. all this bill would do would take it away from community-based health centers where we know there's a shortage because the statistics show if you have a doctor, does residency or a residency program through commoint-based centers they'll more likely go back there and practice, whether it be pediatrician, whether it be family practice, whether it be internal medicine. that's where we need to have the growth and to have primary care physicians. this is a direct attack on health care and on the country. why wouldn't we want it mandatory for community-based facilities if it's already mandatory for hospital training physicians? we need physicians in the community, not just in the hospitals. and if my colleague's ready to close i can yield back my time,

mr. speaker. i yield back my time. the chair: the gentleman from kentucky is recognized. mr. guthrie: i yield myself such time as i may consume. the chair: the gentleman is recognized. mr. guthrie: i'm here to say it is important that we have adequate supply of primary care physicians. it's important public policy nor country. it is important that we also have oversight and control over the budget and the way the money is spent. if we do -- we do that through the appropriations process. after all the effort and there was great effort in putting together the last congress, the health care bill. when we passed out of this congress, the house-passed version, this was an authorized subject to appropriations section of the bill. so i know it's been kind of described as this is against health care through the country but that's the way that, through much debate, it passed

out of this house of representatives. it treats it similar to hospital-based education and primary care, children's hospital-based, it puts it on equal footing with nurses programs, nurse practitioner programs, and other programs. we all agree we have shortages and need more people. i want to reiterate, this does not eliminate the program, it authorizes it and what it does change is from the direct appropriation to an authorized and a appropriation through the appropriating -- through the regular appropriating agent process. with that, i yield back. the chair: the gentleman from kentucky yields back. all time for yen debate has expired. pursuant to the rule, the bill shall be considered for amendment urn the five-minute rule no amendment shall be in order except those received for printing in the congressional record designated for that purpose in a daily issue dated maye 23, 2011, and except pro forma amendments for the

purpose of debate. each amendment so received may be offered only by the member who caused it to be printed or a designee and shall be considered read. are there any amendments to the bill? for what purpose does the gentleman rise? >> i have an amendment from the desk printed as amendment number 2 to h.r. 1216 in the congressional record. the chair: the clerk will designate the amendment. the clerk: amendment number 2 printed in the congressional record, offered by mr. tonko of new york. the chair: the gentleman is recognized for five minutes. mr. tonko: thank you, mr. chairman. my friends on the other side of the aisle seem steadfast and determined on their attack to health care. couple that with their attempt to end medicare and the nation's seniors are put in a bind. they want to put health care in the hands of wall street and big insurance, instead of

between the doctor and patient. they see the tax breaks if millionaires and billionaires and handouts for big oil and are vehemently opposed to this plan. today we have yet another assault on affordable access to health care. my republican colleagues found their new bookyman, family practice physicians. this is unfortunate as we have a dire shortage of those. in igs to 45,000 primary care physicians required by 2020 just to meet america's health care needs. a few months ago, both sides of the aisle agreed on the need to pilled our primary care work force, a proven way to bend the health care cost curve by prevention and early screening. the republicans have changed their tune. they say it's not that we have a shortage of these crucial doctors, instead they must believe we have too many primary care physicians.

so we face a call to eliminate training of those on the front lines of the fight for call care. the underlying legislation guts funding across the country. teaching health centers are residency programs for primary care physicians, providing community-based training to doctors who will work in rural or underserved areas. my friends on the other side have proposed time and time again policies that put americans on the line and let wall treat and big insurance take over and earn big. the constituents in my home drigget in the capital reof new york state need a break. they are looking at the price of gas, the price of food an the price of prescription drugs and wondering how they'll make it through the month do we need to balance the budget? yes. do we need to balance the budget on the backs of hard working americans that play by the ewell? absolutely not. mr. chairman, my amendment is very simple. it requires that we find out exactly how many primary care physicians we will lose if

republicans succeed in cutting teaching hell centers across our country. my amendment commissions the government accountability office to report on these findings so the american people can see how drastically these cuts will eliminate jobs and hurt the quality access and affordability of health care options. i'm anxious to know if some of my colleagues are aware that if this is adopted there will be fewer primary care doctors working in their community. this cuts funding for 23 physicians in the heart of pennsylvania. they are being trained to provide health care for residents in the scranton area. if any republican colleague from the scranton areas joins the republican leadership in supporting this program, his community will lose the funding for 23 positions, that's 23 jobs and the positions they support.

if my republican colleague would like to come to the floor and defend scranton against this unjust attack i will yield him time. the same problem is faced by my colleague from the billings, montana, area, who will lose funding for pgses. in idaho, illinois, texas and washington the same story. they are seeing good american jobs put at risk. they are paying for more tax breaks to millionaires, billionaires and the wealthiest corporations on earth. i would yield my republican colleagues time to defend their constituents. my amendment is a matter of effective oversight. it asks that we find out from a nonpartisan source exactly how many primary care physicians we will lose if the republican leadership moves forward to cut teaching health centers across our country. when it comes to ensuring our constituents have access to basic primary health care, when it comes to protecting medicare

and social security while we're seniors and ensuring they have a healthy and comfortable retirement, there should be no disagreement. please, join me in supporting this amendment and standing with middle class americans across the country. thank you, mr. chairman. with that, i yield back. the chair: the gentleman from new york yields back. for what purpose does the gentleman from kentucky rise? mr. guthrie: to speak on the amendment, mr. chairman. the chair: the gentleman wishes to be recognized on the amendment. mr. guthrie: to strike the last word. the chair: the gentleman is recognized for five minutes. mr. guthrie: i rise in opposition to the amendment. i want to point out the list read of teaching health centers, the tech of the bill is clear ewith only rescind unobligated funding nesm funding has been obligated, it continues to move forward. the list read, those will be funded. the amendment before us directs the g.a.o. to determine the number of physicians that will be trained by this program if funds are not kept mandatory. i oppose the general premise

that a program must have mandatory funding to be effective this has led us to massive budget deficits as far as the eye i can see. during the bait, i remember a few members complaining that reduction on discretionary spending will have little impact on the deficit. there is some truth to the fact that discretionary spening comprises an increasingly smaller share of the budget. it seems to me that some people's ideas is to shift program from discretionary to mandatoried on let spending cruise on autopilot. that's not responsible. at a time of $1.5 billion annual deficits we must set priorities. however, that involves tough choiceful. the people who oppose this bill do so because they are unwilling to make the choices on what the federal government should fund and what they should not. let's review what happened.

certain programs were made mandatory and others were subject to future appropriations. listen to the debate today. it is apparent that some believe that any provision in the health care act that authorizes a program subject to appropriations is essentially meaningless an did nothing at all. however, members extol the virtues of dental training programs but they are subject to further appropriations. when was the amendment to the health reform bill that asked g.a.o. to look into how the lack of mandatory spending would affect geriatric education? there wasn't one. not a single member of the other side brought the issue up. the reason the other side didn't bring it up is because the programs were constructed in a way to go through the normal authorization an appropriations process. the underlying bill simply puts teaching health centers on equal footing with the myriad of other programs. i also oppose the amendment because it's a waste of federal resources. we are asking the g.a.o. to

conduct a study that's almost impossible for it to complete. g.a.o. can't determine the number of physicians that will be trained because so much they have program is under the discretion of the secretary. the contours of the program have not even been set. the health resources and services administration doesn't anticipate the proposed rule making on the teaching health center graduate education program until december. under my bill, supporters of the program will continue to be able to make the case on an annual basis that the program is not duplicative, it is effective, and warrants continued funding over other programs like children's hospitals which the president's budget zeros outism urge my colleagues to vote no and i yield back. the chair: all time for debate having expired, the question is on the amendment offered by the gentleman from new york. those in favor say aye. those opposed, no. in the opinion of the chair, the noes have it. mr. tonko: i ask for a recorded

vote. the chair: pursuant to clause 6 of rule 18, further proceedings on the amendment offered by the gentleman from new york will be postponed. are there further amendments? for what purpose does the gentleman from california rise? >> thank you, mr. chairman. i have an amendment, number nine, at the desk. the chair: the clerk will report the amendment. the clerk: amendment number nine printed in the congressional record offered by mr. cardoza of california. the chair: the gentleman from california is recognized for five minutes. mr. cardoza: thank you, mr. chairman. i rise to offer an amendment that would require the g.a.o. to conduct a study that highlights the impact that elimination of funding would have on the number of physicians that would be trained if this program were allowed to continue as intended. countless studies have demonstrated a serious and growing shortage of health professionals facing the united

states. most critically a shortage of primary care physicians and dentists. however, where i come from, there's also a shortage of specialties as well. with an existing shortage well established and an aging population increasing, our country desperately needs investments in the health care work force, not rescissions. in my home state of california alone, there are 567 designated health professional shortage areas, which include a population of more than 3.8 million medically underserved individuals. in california's central san joaquin value, there are already less than 87 primary care physicians for 100,000 patients of population. the doctor-patient ratio in my reis not getting better, it's getting significantly worse. that's why i consistently advocated for the need to improve access to care and address this vital shortage. all eight counties in the san

joaquin valley have been designated as medically underserved by the department of health and human services, including san joaquin, and fresno counties. a few years ago, we were down to one pediatrician for the entire county of merced. with the passage of the affordable care act, we were able to include additional funding to help address the mounding professional shortage in already underserved areas. the new teaching health center's graduate education is supposed to be ay to deal with the reality of increasing demands on an already strained health care system. studies have shown the most effective way to attract and retain new doctors is to allow medical students to pleat their residency programs in the communities that are in need. graduating physicians most often practice in the communities where they have completed their residency

traping, which is why this program is uniquely important my wife is a perfect case in point. a primary care physician who stayed in our community an practiced for 18 years after she finished the program. without these critical investment the lack of care will most certainly have a costly price on health and well being of many rural, underserved communities, including those i represent. mr. chairman, i reserve the balance of my time. the chair: the gentleman may not reserve his time. does the gentleman yield back his time? mr. cardoza: i yield back. the chair: the gentleman from california yields back his time. for what purpose does the gentleman from kentucky rise? mr. guthrie: thank you, mr. chairman. to speak on the amendment or strike the last word. the chair: the gentleman is recognized for five minutes. mr. guthrie: thank you, mr. chairman. this amendment is very similar to the previous amendment we discussed so i'll be brief. one, as i said before, it's

difficult for the government accountability office, almost impossible for them to perform the study moving forward because there's so much discretion that's given to the health and human services secretary, and as i said before, the health resources and service administration does not even anticipate issuing a notice of proposed rulemaking on teaching health graduate centers until december. then, again, as one of the comments today, you know, i don't think that moving an authorized mandatory spending to an authorized and manned toring spending program -- mandatory spending program makes that program meaningless. if it did, then the other programs, training in children's hospitals, training in behavioral education and health, training in nurse retention, train in nurse practitioners, then those

programs in the health care act would not have the -- as much strength as well. and so just the comments that by moving this from one part of the budget to the other makes it meaningless, to me it's just not accurate. second, i also want to stress again the language of the bill is clear. we do not rescind obligated funds. it's only unobligated funds. so, again, it wasn't with my friend from california but earlier mentioned there were programs that had already been in place that would be hurt by that. that's -- if the funds had been obligated those programs would move forward. i yield back my time. the chair: all time having expired -- for what purpose does the gentleman from texas rise? mr. green: strike the last word. the chair: the gentleman is recognized for five minutes. mr. green: mr. speaker, members, what i'd like to do is i know there's been talk about only obligated money. i'd like to ask unanimous consent to introduce in the record a press release issued on january 25 of this year from

health of human services mentioning the graduate education program. of the program it lists the ones, and that money is obligated but there will be no future funding for them. so you get a few months of funding but you don't get any more funding. that's why i'd like to add this list -- the chair: the gentleman's request will be covered by general leave. the gentleman may proceed. mr. green: ok. thank you. i'd leek to introduce this in the record -- i'd like to introduce this in the record because six centers are in republican districts, five democratic districts will get a short three months' worth of funding if this bill becomes law. and they will not -- it doesn't do any good. graduate medical education pays for the training of that physician. these community centers will only receive short term. it may be only talking about that obligated money but they will no longer get any more after this year. if this bill becomes law.

that's why it's so important that this bill be defeated or that we adopt an amendment similar to our colleague from california. i ask unanimous consent to place this press release in the record with the listing of the health centers. the chair: again, the gentleman's request will be covered under general leave. are there further debate on this amendment? if not -- for what purpose does the gentleman from minnesota rise? >> i move to strike the last word. the chair: the gentleman is recognized for five minutes. mr. ellison: mr. chair, i move to strike the last word and to rise in opposition to this underlying bill. as the senate votes this week on the republican's scheme to end medicare, i'm standing up to protect health care for our seniors. our seniors, they've blazed a trail for all of us. they fought the wars. they've earned the money. they've come and made america a great place and we ought to

inherit what we have done. we've inherited what our senior citizens have made for us, and now we see our republican colleagues want to end medicare for these same seniors, to end -- to spend nearly a trillion dollars on handouts to millionaires, not only harms america's seniors but threatens our economic future. medicare guarantees a healthy and secure retirement for americans who pay into it their whole lives, mr. chairman. it represent a basic american value of fairness, decency and respect for our seniors that all americans should cherish. last month our republican colleagues voted to end medicare as we know it. according to the congressional budget office, and, mr. chairman, that's the budget office that is straight and calls it as they see it. it said it would raise health

care for seniors by more than $6,000 a year. $6,000. that's a lot of money, mr. chairman. more than doubling their cost. instead of fulfilling a promise to our seniors, a promise that the people who gave everything for us would have something in their golden years, the plan would bring about a corporate takeover of our health care. insurance company bureaucrats would be able to deny seniors care they have paid into for their entire lives. the g.o.p. plan no longer guarantees seniors the same level of benefits and choice of a doctor that they have today under medicare. mr. chairman, this debate is not about the deficit. only if it were. this debate is about something else, and it is about whether we are going to meet the promises of our seniors, of our

children, of our students, of our public employees or not. it's a choice of whether we're going to put america to work or not. it's a basic choice about how we're going to live together. mr. chairman, this debate is not about a deficit, and as my fellow colleagues pound on this idea that we're broke, we're not broke. what we are is unwilling to do the basics for people who have given america so much. this debate is not about a deficit because we can reduce the deficit by putting america back to work. 2/3 of american corporations don't pay any taxes, including general electric, bank of america and others. if we ask people to just do their fair share, america's not broke. by siding with insurance lobbyists to raise insurance costs only i creases the burden -- increases the burden on our seniors. like i said, this is not about the deficit. raising taxes for 95% of

americans to pay for $1 trillion tax cut for c.e.o.'s who ship american jobs overseas sides with the rich at the expense of the middle class. spending billions on handouts for corporate special interests including $40 bill on big oil only drives up the price at the pump for families already hurting the most. the progressive caucus, mr. chair, has a plan that puts people's priorities first. our budget, which we call the people's budget, strengthens medicare and social security. it lets medicare negotiate cheaper drug prices so insurance company bureaucrats can't deny you the medication you need and it creates jobs by eliminating the deficit by 2021. that's right. the progressive caucus eliminates the deficit. that is the fiscally responsible budget. that's a budget the americans can get behind. not so budget that rewards the

rich at the expense of everybody else and doesn't do anything to end the deficit. i'm not standing for a budget that throws seniors under the bus. we have an obligation to honor the seniors, honoring the greatest generation, the generation that brought us civil rights, human rights, women's rights. the generation that brought us medicare. we are in a generation to fight, mr. chairman, and generations will look back on us and ask, why did we let the republican caucus take away the basic promises of america? and we will be able to stand now and say we didn't. we fought them back and we fought for america where everybody does better because everybody does better, including our seniors. i yield back. the chair: the gentleman from minnesota's time has expired. are there further requests for time? the debate -- for what purpose

does -- ms. foxx: mr. chairman, i have an amendment at the desk. the chair: the lady will suspend. we have not dispensed with the prior amendment yet. the question is on the amendment offered by the gentleman from california. those in favor say aye. those opposed, no. in the opinion of the chair, the noes have it. mr. cardoza: mr. chairman, i ask a recorded vote. the chair: the gentleman requests a recorded vote. pursuant to clause 6 of rule 18, further proceedings on the amendment offered by the gentleman from california will be postponed. now, for what purpose does the lady from north carolina rise? ms. foxx: mr. chairman, i have an amendment at the desk, amendment number 7 as preprinted mountain congressional record. the chair: the clerk will designate the amendment. the clerk: amendment number 7 printed in the congressional record offered by ms. foxx of north carolina. the chair: the lady from north carolina is recognized for five minutes. ms. foxx: thank you, mr.

speaker. my amendment is designed to protect life and the livelihood of those who defend it. since 1973, approximately 50 million children have been aborted in the united states. this is a tragedy. according to a cnn poll last month, more than 60% of americans oppose taxpayer funding for abortion. this number includes many of my constituents and is consistent with my strong pro-life convinkses. i'm offering my amendment today to ensure that their hard-earned money will not be used to pay for elective abortions or give to organizations that discriminate against pro-life health care providers. earlier this month the house passed h.r. 3, the no taxpayer funding for abortion act, which codifies many long-standing pro-life provisions and ensures that taxpayer money is mott being used to perform -- not being used to perform elected abortions. it is now awaiting consideration in the senate. i will not cease to fight for

the unborn children in america. this amendment ensures that the money -- makes it crystal clear that taxpayer money is not being used to train health care providers to perform abortion procedures. when the liberals rammed through their government takeover of health care in an unprecedented fashion they refused to include long-standing pro-life provisions. with this bill, house republicans are seeking to restore a grant program for residency programs through the regular appropriations process and my amendment explicitly and permanently ensures that it should the appropriations committee fund this program, taxpayer money will not be used to pay for elected abortions or train abortion providers. in addition to the need for elected abortions, it is also important that scarce resources are allocated to the most worthy applicants and applicants that demands that individuals and institutions provide or refer for abortions

is simply not the kind of applicant that should be funded under this program. numerous doctors, nurses and other health care providers refuse to perform or participate in abortions because they believe it is wrong to kill a child. congress should ensure that these individuals are not discriminated against because of their belief. any form of discrimination is poor and an individual should not be forced to act against their conviction. this is similar to previous efforts to protect pro-life health care providers and is consistent with these efforts. to be eligible for funding under this grant program, centers have to agree that they will not discriminate against pro-life health care providers. my colleagues across the aisle may argue that we already have the hyde amendment that prohibits taxpayer funding for elected abortion for programs that are included in the labor, health and human services and education appropriations legislation. however, this amendment must be included every year. my amendment ends the uncertainty for this program by providing a permanent prohibition on taxpayer funded

elected abortions and protects pro-life health care providers. until we have a permanent prohibition on taxpayer funding for elected abortion and protections for health care providers that cherish life i will continue to offer and support efforts to support taxpayers' families and children from the scourge of abortion. the unborn are the most innocent and vulnerable members of our society and their right to life must be protected. therefore, i urge my colleagues to vote in favor of this amendment and yield back the balance of my time. the chair: the lady from north carolina yields back her time. for what purpose does the lady from colorado rise? ms. degette: mr. speaker, i rise in opposition to the amendment. the chair: does the lady move to strike the last word? ms. degette: i move to strike the last word. the chair: the lady is recognized for five minutes. ms. degette: thank you, mr. speaker. here we are again forced to stand up again to protecting women's health care against an extreme agenda. i agree with the whole -- disagree with the whole

underlying bill, mr. speaker, but even so, even so, how one could tie restricting a woman's right to choose to graduate medical education is sort of beyond me. and let me explain why this is just an extreme and direct attack on women's health. what it would mean is that across the country residence would be barred from how to perform a basic required procedure required for women's health. this amendment would jeopardize both education and women's health care by obliterating funding for a necessary full range of medical training by health care professionals. and here's the thing. the hyde amendment is the law of the land right now. i don't like the hyde amendment, i would repeal the hyde amendment but frankly the hyde amendment has been in

place for over 30 years and it's not going away. what it says is, no federal funds shall be used for abortions except in the case of rape, incest, or the life of the mother. now, there's nothing in the hyde amendment about restricting medical doctors' training to legal medical procedures. there's nothing about graduate medical education in the hyde amendment whatsoever. and if we pass this amendment, we will not allow basic medical training that would even allow doctors to provide the procedures that are allowed under the hyde amendment. life, rape, or incest. and let me talk about why this is so incredibleably dangerous for women's health. ensuring that doctors and nurses are fully trained in apportion provision is

essential to -- in abortion provision is essential to ensuring that they can provide live-doctor life-saving care when abortion is a necessary procedure to save the life of a woman. most pregnancies progress normally, but sometimes there is a problem and time an abortion is necessary to protect the woman's life. for example, in cases of pre-ecclampsia, or bleeding placenta preva, which can be fatal, an abortion is a life-saving procedure. in addition if managing a miscarriage, sometimes an abortion procedure is essential to saving the woman's life. now under this amendment, virtually any type of health care facility could face a loss of funding if they needed to provide abortion care in an emergency situation. moreover, mr. speaker,

residents need to be trained in how to handle these complicated conditions that could necessitate an abortion. i'm afraid to say, these cases are real. the case of a woman facing severe hypertension faced her house when a none was excommunicated for allowing the woman's life to be saved through an abortion. the foxx amendment would greatly expand the reasons why health care entities should give and -- in refusing care. so mr. speaker, here's the thing. maybe we don't like abortions and all of us wish abortions would be rare. but sadly, even in the case of a wanted child with a loving home and everything else, even in the case of an exception under the hyde amendment, sometimes abortions are necessary. and if we say we are not going to train doctors how to provide

a range of women's health care services, then we are basically allowing women to bleed to death in the emergency rooms of this country. and i don't think that's what this congress is about, it is certainly not what the medical profession is about. i would urge, for just -- for reasons of mercy, for congress to -- for this house to reject this amendment, it's mean-spirited and as far -- and is far, far beyond current law. with that, mr. speaker, i yield back. the chair: the gentlelady from kohl yields back rp for what purpose does the gentleman from california rise? >> mr. chairman to strike the last word. the chair: the gentleman is recognized for five minutes. >> mr. chairman, i find myself in opposition to the underlying bill and to the amendment. mr. garamendi: you heard a very cogent argument. i don't understand why we ought

to have ignorant doctors. doesn't make any sense to me. abortions are sometimes necessary for saving the life of a pregnant woman and to have a medical system in which doctors don't know about that procedure is really stupid. i won't say this amendment is that, but it's really not wise to have ignorant physicians. and it's really not wise not to have physicians at all. what in the world are we thinking here? what's the purpose of this amendment and this particular resolution? to deny american men, women, and children the opportunity to go to a doctor? we know all across this nation that there is a shortage of primary care physicians, in most of california there a a -- is a shortage of primary care physicians.

plenty of dermatologists, but not primary care fi sigs. what are we going to do here? eliminate the funding to train primary care physicians. that in itself is bad enough. but this is just one piece of a much larger plan to dismantle health care in america. the repeal of the affordable health care act will increase the cost of medical services all across this nation and particularly increase the cost to government. not my projection, the independent congressional budget office said clearly that the affordable health care will reduce the cost of medicare and medicaid. so repeal it. increase the deficit. is that what this is all about? i don't get it, guys, and women, it makes no sense to me. and now in your budget, the republicans go after medicare

and terminate medicare for every american who is not yet over 55 years of age? terminate it. and turn over to the rapacious, greedy, profit before people health insurance industry, an industry that i know a great deal about, i was the insurance commissioner in california for eight years and i know those characters. it is about profit. it's not about caring for people. and when you say they government -- say the government shouldn't make decisions, the government does not make decisions in medicare. the physicians make decisions. but if you turn medicare over to the insurance companies, it will be the insurance companies that make decisions about medical services and by the way, you also voted to repeal those sections of the affordable health care act that protect all of us from the

rapaciousness of the health insurance industry, eliminating the law eliminates such things as pre-existing conditions. age. sex distrim -- discrimination and the rest. you repeal that and give back to insurance companies the opportunity to discriminate. and now you want to throw tomorrow's seniors into that same pool of sharks. i don't get it. it makes no sense whatsoever. it perhaps is the worst idea i've heard in a 35 -- in the 35-years i've been involved -- involved in public health and public policy. it makes no sense whatsoever. and this bill on top of it, come on. we're not going to train, we're not going to train primary care physicians? what in the world are you thinking? i don't get it. i don't get the whole strategy. it is a strategy that will put america's health at risk. it is a strategy that will deny

benefits. it is a strategy that will provide with us this latest amendment, doctors that are ignorant about basic women's health and it is a stralty that will deny us the necessary primary care physicians. wow. what in the world are my republican colleagues doing here. about the deficit? come on now. what you are doing is going to increase the deficit. you're going to increase the deficit if there are in the primary care physicians, then you'll go to the emergency room and everybody knows that the emergency room is more ex-pepsive than a doctor's office. what are you doing? i don't get it, guys. i don't understand. you're worried about the deficit yet you take action that increases the deficit, it makes no sense to me. mr. chairman, i wreeled back my remaining time.

>> mr. chairman, i move to strike the last word. the chair: the gentleman from texas is recognized. mr. green: thank you, madam chairwoman. i have the utmost respect for ms. foxx of north carolina. but graduate medical training does not do abortions. there's no payment for services in the laws. it's about salaries, benefits, and paying faculty. teaching facilities will pay for abortions no more than graduate care has paid for abortions for 45 years. the president signed the executive orders to make all the provisions summit to the hyde amendment. all provisions of the affordable care act subject to the hyde amendment. it establish asset of policies to ensure that federal funds are not used for abortion services consistent with the hyde amendment.

the president's order reinforces what we all agree on. no one is here claiming we should use federal funds for abortion except in limited circumstances, whether under this program or elsewhere. there's another lay ore of protection codified in permanent law, the public health service act. the coats amendment clearly prohibits the federal government from discriminating against any physician, post-graduate physician training program because the sent i -- entity refuses to participate in bay aabortion training. that's not an appropriations vehicle. it's not an executive order, it's the law of the land. that's why i say this amendment is a solution in search of a problem. there's not a problem with graduate medical education whether they be teaching hospitals, whether they be community-based centers that this bill is subject to to, and i yield back my time. the chair: the gentleman yields back. the gentlewoman from california.

>> madam speaker, i move to strike the last word. the chair: the gentlewoman is recognized for five minutes. >> i rise to speak in strong opposition to this dangerous amendment. i have with me a letter from the american congress of obstetricians and gynecologists opposing the foxx amendment to h.r. 1216 which i ask unanimous consent to have inserted into the record. the chair: the gentlewoman's request is covered by request for yen leave. ms. schakowsky: last month the republican majority brought us to the brink of government shut down over its disapproval of planned parenthood. mrs. capps: this time instead of saying congress knows better about a woman and her family about her reproductive health care, this takes one step further and says congress knows better than medical doctors and educators about what our medical training curricula should look like.

this is an unprecedented restriction, one that gos against the accreditation council and fens medical ethics themselves. medical education is supposed to prepare our future doctors for whatever they may come across in their practice. this includes women whose lives are in danger due to their pregnancy for which terminating a pregnancy is the only way that woman will stay alive. keeping future providers from learning these procedures, and it is an option that they may choose only if they choose to learn it, puts these women at risk. regardless of what one's views on women's reproductive rights, i think we can all agree our future medical providers should be trained and ready for any medical emergency they might encounter. to play politics with their education and the lives of women is an embarrassment. madam speaker, it is time for

this congress to learn to trust the american people. to trust our doctors to trust our families, and to trust women. i yield back the balance of my time. the chair: the gentlewoman yields back. the gentleman from new york. >> madam chair, i move to strike the last word. the chair: the gentleman is recognized for five minutes. >> thank you, madam chair. i rise in opposition to h.r. 1216, the underlying bill. as a resident of update new york, where much attention has been given to today's spec election far congressional seat, people are saying loud and clear, hands off my medicare. mr. tonko: the republicans are once again putting us on the road to ruin. they are pushing forward to end a program that 46 million seniors and disabled individuals depend on for their health care. this gross injustice is made more egregious by the fact that this is done not to balance the budget to expand and perm neptly guarantee even bigger tax cuts for millionaires an

billionaires and give tax breaks to some of the most profitable companies, including oil. i have heard a lot of talk about the need to make tough choices these day. the average senior on medicare earns just over $19,000 a year. one quarter of medicare beneficiaries suffers from a cognitive or mental impairment. i ask my republican colleagues, what is it about stripping these americans bare of their health and economic security that wall fis as tough? there's nothing tough about stealing from the poor or weak to give to the rich. our seniors know about all tough choices doifment buy grows riss or prescriptions? do i pay rent or medical bills. it hurts but how much will it cost? these are the tough choices, these are life and death choices. with the passage of medicare in 1965 we entered into a covenebt with each and every american

citizen. a seniors will be on their own with a measly voucher and forced to buy insurance in the private market where all decisions will be profit-driven. more profits for insurance companies on the backs of seniors. sounds like a republican plan to me. this new voucher program amounts to a rationing. the voucher is not linked to increases in health care costs, yet the cost of private health insurance have risen over 5,000% since the creation of medicare. 5,000%. the analysis of the nonpartisan congressional office has estimated that in less than 20 years these vouchers would pay just 32 cents on every $1 that a senior would spend on health care premiums. now, the republican leadership has repeatedly stated that this budget gives seniors the same coverage as members of congress. well, as a member of congress myself, i know that our health plans pay for about 72 cents on every $1 of health care, not 32 cents. america knows that legislation in congress carries a statement

of priorities and values. not purely dollars and cents. and what sense does it make to cut training for primary care physicians who are on the front lines not only of keeping our constituents and communities healthy, but also of lowering health care costs with early, simple treatments? i urge my colleagues to stand with our seniors and stand up for middle class priorities. let's defend our middle class, let's defend our working families. i urge my colleagues to oppose this bill and with that, madam chair, i yield back. the chair: the gentleman yields back the balance of his time. the gentlewoman from massachusetts. >> i move to strike the last word. the chair: the gentlewoman is recognized. >> i rise to undermine our constituents' access to affordable health care. ms. tsongas: i recently heard from my constituent from massachusetts named phil who relies on medicare for his health coverage.

his wife's diabetes treatment and prescription drugs are also covered through medicare and they have both paid into medicare all their lives through payroll deductions. he remarked to my office that there was no way that they could meet the cost of health care today without medicare. he and his wife are not alone. each day thousands of seniors like them use medicare to cover the costs of doctors' appointments, prescription drugs as well as routine tests and treatments. under the budget that house republicans passed in april and that the senate is set to consider this week the medicare program that seniors have relied on for more than 50 years to meet their medical needs and expenses would be eliminated. in its place would be a voucher system that pays a small lump sum to private insurers to cover seniors. any cost not covered by that payment would fall to seniors to pay or forego coverage.

my colleagues on the other side of the aisle argue that elimination of medicare is needed to help reduce the deficit and that the same benefits that seniors now enjoy under medicare will be recommend cated in the private insurance -- replicated in the private insurance market. not so in reality their plan will result in a far -- not so. in reality their plan will result in a far lower care for seniors while trillions of dollars will be added to the national debt. rather than taking steps to reduce the underlying increases in health care costs which in turn drive up the cost of medicare, their plan simply shifts those costs to seniors. the value of the vouchers that would replace medicare would not keep pace with rising health care costs, so seniors will be increasingly required to make up the difference. just eight years after the program's start, a vouch already cover less than 1/3 of the cost of a private health insurance package with the same benefits as medicare currently provides. leaving seniors to cover the rest.

according to the nonpartisan congressional budget office, the average senior will end up spending nearly twice as much of their income on health care than under the current medicare system. that is why a.a.r. -- aarp released a statement warning that the bigget, quote, would result in a large cost shift in the future employees. the republican proposal, rather than tackling skyrocketing health care costs, would simply shift those costs onto the backs of people in medicare. unquote. instead of focusing on cost control measures that would bring down the cost of medicare, the budget claims cost savings but only by passing those costs directly onto our seniors. furthermore, because costs have typically grown faster in the private market than in medicare the costs faced by seniors under the republican plan will be much higher than the costs faced by the federal government now. my colleagues have argued that seniors won't be affected by these costs for years to come, but this is simply not true.

for example, the house budget immediately reopens a prescription drug doughnut hole for current seniors that was fixed with passage of last year's health reform law. it also significantly increases costs for seniors now residing in nursing homes and for their adult children who may not be able to afford their parents' care. despite being presented as a solution for our deficit, the budget proposal would still add $8 trillion to the national debt over the next 10 years. these new debts are incurred in part because their budget proposal also slashes taxes for the wealthiest americans while continuing to provide billions in tax breaks for oil companies and other preferred industries. real deficit reduction will require a blend of spending reductions, new revenue and additional reforms to control rising health care costs. but simply shifting those costs onto seniors by eliminating medicare will prove as unsustainable for our nation's

well-being as the current budget crisis we face. thank you and i yield back. the chair: the gentlewoman yields back the balance of her time. the gentleman from illinois. >> i move to strike the last word. the chair: the gentleman from illinois is recognized for five minutes. mr. davis: thank you, madam chairman. i rise in opposition to the fox amendment -- foxx amendment and to the underlying bill, h.r. 1216, to amend the public health service act to convert funding for graduate medical education and qualified teaching health centers from direct appropriations to an authorization of appropriations. this bill would eliminate mandatory funding that establishes new or expanding programs for medicals remain dents in teaching health centers and unobligated funds previously appropriated to the grant program. under policies currently being considered by some in the house majority, academic medical centers and teaching hospitals face as much as $60 billion in cuts over the next 10 years to

medicare funding for indirect medical education and direct graduate medical education. these cuts would reduce indirect medical education payments by 60% from the current level at 5.5% to 2.2%, cap the graduate medical education payments at $1 -- 120% of the national average salary paid to residents. it would reduce federal funding for medical residents in training is wrong public policy. giving our present situation with the shortage of primary care and family practice physicians and the expected future growth of our population, it makes no sense for the republicans to end the present structure of medicare. in 2010 47.5 million people were covered by medicare. we have 39.6 million at the age

of 65 and older and 7.9 million disabled. the republican budget plan is a voucher plan that would raise health care costs and would immediately create higher costs for prescription drugs for our seniors and disabled. this plan would end medicare's entitlement of guaranteed benefits and promote rationing by private insurance companies who would make decisions on approving our disapproving treatments for our seniors and the disabled. the medicare program is efficiently managed, devoting less than 2% of its funding to administrative expenses. med car haise dramatically improved the quality -- medicare has dramatically improved the quality of life for seniors and the disabled. it is the largest source of health coverage in the nation. democrats are committed to strengthening medicare, not tearing it down.

under the guise of reform, republicans desire to end medicare as we know it today. last year the republicans promised the american people that jobs would be their number one priority. well, i ask, where are the jobs? but instead they want to make draconian cuts to programs to help seniors and the disabled, the middle class, the poor and the needy and yet provide tax cuts for over $1 trillion to millionaires and billionaires and so we ask, where are the jobs and where are the opportunities? the estimated one-year impact of anticipated graduate medical education cuts for illinois are $144 million. for indirect medical education and $39 million for graduate medical education which totals $183 million. if they are -- if there are no

doctors, there can be no medical care. i urge that we vote against these measures and i yield back the balance of my time. the chair: the gentleman yields back the balance of his time. the gentlewoman from california. >> i move to strike the last word. the chair: the gentlewoman is recognized for five minutes. ms. waters: thank you very much, madam chair. i rise in opposition to the underlying bill, h.r. 1216, which would undermine the teaching health center program which trains primary care physicians. madam speaker and members, this is just one more attempt by the republicans to dismantle health care reform. they're going after the training of primary doctors. we need more primary doctors even if there was no health care reform. there are many communities throughout this country who have no primary health care physicians. our nation is facing a serious shortage of primary care

physicians, primary care physicians are an essential part of a successful health care system. they're at the first point of contact for people of all ages who need basic health care services, whether they're working people with employer-provided health insurance, low income children on medicaid or seniors on medicare. the republicans have made it clear that they're not concerned about access to basic health care services. the republican budget for fiscal year 2012 turns medicare into a voucher program. slashes medicaid by more than $700 billion over the next decade and cancels the expansion of health insurance coverage which was included in the affordable care act last year. the republicans' budget cuts to medicare are especially detrimental to current and future medicare recipients. under the republican budget

individuals who are 54 and younger will not get government-paid medicare benefits like their parents and grandparents. instead they will receive a voucher-like payment to purchase health insurance from a private insurance company. there will be no oversight to these private programs. we will not be able to contain the cost, we will not be able to mandate what the basic services should be. as a matter of fact we know the stories about the h.m.o.'s and the fact that they had accounts who determined -- accountants who determined what care could you get. not physicians who had the knowledge and the ability to determine what you need. when the first of these seniors retire in 2022, they will receive an average of $8,000 to buy a private insurance plan, that is much less than the amount of the subsidy members of congress receive for our health plans today. the coverage gap in the medicare

prescription drug program will continue indefinitely. under the affordable care act this so-called doughnut hole is scheduled to be phased out. the republican budget will allow seniors to continue to pay exorbitant prices for their prescriptions when they reach the doughnut hole. the republican budget also gradually increases the age of eligibility for medicare from 65 to 67 years of age. madam speaker, the republican budget is also detrimental to americans who depend again on medicaid, including low income children, disabled americans and seniors in nursing homes. the budget converts medicaid into a block grant program and allows states to reduce benefits, cut payments to doctors, even freeze enrollment. medicaid funding is slashed by more than $700 billion over the next decade. that is over 1/3 of the

program's funding. meanwhile the republican budget extends the bush era tax cuts, beyond their expiration in 2012, and cuts the top individual tax rate down to 25% from 35%. according to the center for tax justice, the republican budget cuts taxes for the richest 1% of americans by 15% while raising taxes for the lowest income 20% of americans by 12%. the national shortage of primary care doctors is not a problem for multimillionaires. they will always be able to find a doctor who will treat them and pay them whatever they ask for. but most americans -- america's seniors need well-trained primary care physicians and medicare benefits that they can rely on. i urge my colleagues to oppose the underlying bill, oppose the

republican plan to dismantle medicare. they're trying to dismantle health care reform piece by piece, inch by inch, today is an attack on training needed primary care physicians. what sit tomorrow? we know they have a strategy that includes hundreds of bills that will dismantle, again, piece by piece, medicare reform. it's not fair, madam speaker and members. health care reform in which all merps are covered is something we should support. i yield back my time. the chair: the gentlewoman from california. >> madam speaker, i move to strike the last word. the chair: the gentlewoman is recognized for five minutes. ms. woolsey: i rise in opposition to this amendment and the underlying bill, h.r. 1216. this is just the last attempt, the latest and newest attempt by the majority to stall health care reform and undermine the

health security of the american people. we have barely taken our oaths inian when they voted to repeal the affordable care act. now trying to eliminate title 10:00 funding that creates critical primary care for women an last month they went after the funding for the health care exchanges and voted to cut grants for school-based health centers that served young children. but worst of all is the republican budget resolution that was passed last month. it rips the heart out of medicare, eviscerates, disfigures, a program that would no longer be recognized. it's one of the more radical proposals i have seen in 18 years in congress. they want to strip guaranteed benefits and break the american promise that served our seniors so well for nearly half a century. and what do they replace it with? a voucher. a voucher that won't be able to keep up with soaring health

care costs, a voucher that will give seniors no leverage in the health care marketplace, a voucher that will put older americans at the mercy of the insurance company. madam chairwoman, the c.b.o. has concluded that the republican proposal will double health care costs for seniors. so, if you're 54 years old today, you'd need to ave an additional $182,000 to make up for the medicare benefits you'll lose under the republican plan. and they're not content to destroy medicare. medicaid comes in for brutal treatment as well. by converting to it a block grant, they would be throwing as many as 44 million americans off the insurance rolls, eliminating coverage for the poorest people, most nursing home residents and people with disabilities. my friends on the other side of

the aisle who say we have to do this to blaps the budget, they know they're wrong. i say they're dead wrong. we do not need to put seniors and low income americans on an austerity program in order to rein in the deficit. we do not need to shred the social safety net or squeeze the middle class in order to get our fiscal house in order. in fact, we can save taxpayers $68 billion over seven years and expand the menu of health care choices by instituting a public option. if you ask the american people, they'd rather see some shared sacrifice in cutting spending. they'd rather see us eliminate tax breaks for c.e.o.'s who have no idea what it's like to choose between taking their medication or eating their next meal. madam chairwoman, i'll vote no on h.r. 1216, it's just another

example of republican negly johnson and callousness on health care. they clearly prefer the broken system that leaves millions uninsured, imposing crippling costs that bankrupt families and bankrupt small businesses. the majority doesn't want to solve the health care crisis. they want to exacerbate it. with that, i yield back. the chair: the gentlewoman yields back. the gentlewoman from california. >> i move to strike the last word as i rise to speak in opposition to h.r. 1216. the chair: the gentlewoman is recognized for five minutes. ms. richardson: urn the guise of deficit reduction, republicans are attempting to attack our nation's vital support system for our senior. the republican budget would deny seniors and those who are coming forward after those that are currently taking advantage of these benefits, health care,

long-term care, and the social security benefits that these seniors have earned. sunday evening, i just got back from my district where i had an opportunity to have our annual senior briefing. there were over 900 seniors there and they were concerned. i spoke with several of my seniors in my district and they're worried about how they and even some of their parents who are in their 90's today will be able to get by once ryan care, is what i'm going to call it, the attack on medicare which would destroy something we all need. by following ryancare and turning medicare into a voucher program, republicans would gradually eliminate the peace of mind that many of our seepors have grown to be able to count on. we don't want to go back to the ole dis of calling seniors poor and not having an opportunity to live in dignity in the last years. these fixed value vouchers,

which are being suggested in ryancare, would not only keep up with the rising cost of health care but would cost seniors an additional $17,000 more per year by 2020. in california alone which is where i'm from, under the republican budget, seniors would pay $213 million more on prescription drugs in 2012 alone. that's next year. the republican budget would return our country to a time when being old was something that people would be afraid of, not look forward to. the republican budget would also turn medicaid into a block grant system. haven't we seen what that's done with community development block grants? it wouldn't work. under a block grant system, medicaid would no longer be able to support the elderly. by converting the current medicaid system into a block grant index, congress would shift the burdens to rising health care costs and aging

populations to the states. all you have to do is look at "the los angeles times" to' what's happening to my state and i don't think we'd be able to help the seniors. the deficit must be addressed. in fact, i supported many bills an amendments that have been brought forward on the other side. but it should be done in a fair way. we should not blaps the budget on the backs of our neigh's seniors. not after wall street and our car manufacturers got a bailout. i will, and democrats will, continue to work to protect, strengthen and save social security, medicare and medicaid. madam speaker, i yield back the balance of my time. the chair: the gentlewoman yields back. the gentlewoman from maryland. ms. edwards: i move to strike the last word and rise in opposition to the underlying bill. the chair: the gentlewoman is

recognize. ms. edwards: we have returned to the hill after a hard week at home in their district trying to explain dismantling medicare. the reason it's hard to explain is because there is no explanation. the plan that republicans have under consideration would indeed end medicare as we know it. it would end medicare and it's just that simple. the plan would turn medicare into a voucher system that would leave seniors paying more and more out that have their pockets for health care. you know, i was out at a town hall meeting at a senior center many any -- in my congressional district. it's one where people have come from every level of the private sector to enjoy their retirement. they receive medicare benefits. i asked them, who in this room a room of about 100 seniors, i asked them how much would you like -- how many of you would like to go into negotiations

with your insurance company to see how much you were going to pay for health care? none of those seniors stood up. that's what the ryan pla this medicare dismantling plan would do for seniors. it would say, we want you to go on your own and gobet with the big insurance companies. we know that can happen for those who are younger but it cannot happen for seniors. it would shift the burden to make the system much less inefficient and increase administrative costs that are passed on to all consumers. according to the congressional budget office, the plan would raise the eligibility age from 65 to 67 and while it repeals provisions of the affordable care act that are actually designed to make the system etch more efficient. this just doesn't make sense. i think that seniors have caught on. in fact, i think all americans have caught on. and the thing about medicare is that it it suspect just about our seenors, madam chair. it's about about the contract

that each of us, one yen ration makes to the next generation. it's the contract i've made with my mofere, that my son makes with me an it is to make sure that we're able to be taken care of in our old age pause we paid into it and paid for it. according to the center for economic and policy research a 54-year-old worker would need to save an additional $182,000 a year to pay for the higher costs of private insurance with the government elimination of medicare. $182,000. let's just absorb that for all those 5 -year-olds. how long is going to take you to get to abling 65 or 67 and save $182,000 to pay for your health care costs? well, we know that would be an impossibility. i want to tell you what's happening in maryland because it will happen across this country and it is that our seniors are exnicing that the

g.o.p. plan would require seniors to pay an additional $ 608,000 out of their pocket. that's not including the fact that they'll have to negotiate and probably pay more than that. at a time when our seniors are vulnerable and they're struggling and they've seen a depletion in their savings, it's not fair to threaten them and threaten their quality of life by ensuring that they'll have to pay these out of pocket costs. so, i would ask us, madam chair to really examine what it is that we're asking the american people to absorb. and our seniors, you know, i was up with a group of seniors in new hampshire and throughout my congressional district and our seniors are saying so us, it isn't just about us and don't count on us supporting this plan just because we happen to be over age 55. we support medicare because we understand what it means for future generations. so this is a link a bond

between the young people in this country who are working, our seniors and retirees to protect medicare and protect the benefits that come with it. and i would ask us on this underlying bill, i think my -- some of my colleagues have spoken to this we need more primary care, already we're seeing what's happening in our system, where 26-year-olds, up to 26-year-olds can be covered on their parent's health insurance. you know what that's doing? it's bringing down the costs, making sure we have more resources to absorb the care that people need as they get older. and so let's not stomach a dismantling of the medicare protections that we've known for almost -- for 46 years in this country this contract from one generation to the next generation to ensure that our senior who work sod hard are able to enjoy their retirement without sacrificing everything they have to pay the cost for additional benefits while health insurance companies walk

away with record profits and certainly while oil and gas -- with that, i yield. the chair: the gentleman from kentucky. >> thank you, madam chair. i move to strike the last word. the chair: the gentleman is recognized for five minutes. mr. guthrie: i rise to support the foxx amendment. i was also back home last week and went to a 100th birthday party for a group of people in northern kentucky, the louisville area, that were turning 100 years old. a lady there was 103, born in teddy roosevelt's presidency. i went to do this because i wanted to thank them. i'm a big believe for the what the greatest generation has done for us. i'm a member of the baby boom yen ration, born in 1964, 47 years old. 1946 to 1964, if you were born in 1946, you're in medicare this year. 65 years ole system of one of the -- i wanted to thank them

and let them know what we are doing is making a sustained and secure medicare system for them. we all know last -- end of last week that 2024 is the date put out that we're having medicare -- it goes bankrupt. so what we put together is a real proposal for 10 years to allow people the opportunity adjust that are 54 and younger. there's not a member of the greatest generation, if anybody says different, they're wrong, there's not a member of the greatest generation affected. half the baby boom, half the baby boom is covered -- is not affected by the changes that we have to make to make a secure and better future. i'm 47 years old this means a lot to me, my daughter is 17. you ask a lot of people my age, do we have a better lifestyle than our parents had? the greatest yen ration gave us a -- the greatest generation gave us a better lifestyle

because they wanted to. and if you ask somebody my age, do you think your children have a better lifestyle? and it's bad that they think that they don't. i don't want to be part of a government that doesn't address the fact that we want our children to have a better future. when my daughter is my age, we can pay off the national debt. so think about it. i'm 47 years old, not a $14.3 trillion debt, you ask a lot of people my age, do you think our children will have a better future? they say no, we're going to keep piling on debt an deficits as far as the eye can see. but madam chair, ask me, now, as you think of my daughter at 47 years old, is living in a country with zero national debt, do you think my grandchildren and her grandchildren will have a better future? they will. we're talking about saving and securing medicare for the

greatest generation. we're talking about saving and securing it for people that become older and mo ma -- more mature. so anybody says the greatest generation is affected by this is just not saying what passed out of the house of representatives. if anybody's saying that seniors are affected by this, that's not passed out of the house of representatives to. say we have to reform the program to make it stronger and better for them, that's accurate. and making it stronger and better for those who come forward. that's what we're talking about doing. that's what the facts are. people deserve the facts. people are tired of hearing rhetoric, they want facts and the facts are, we're sustaining and securing it for the greatest generation and reforming it so it will be there as our children mature and if we pass the budget as the senate would pass the budget that we passed out of the house, when my daughter is my age, we'll have zero national debt. we'll have a better future and then ask her if she thinks her children will have a better

future than she did and i guarantee that you she will say that. i yield back. the chair: the gentleman yields back the balance of his time. the gentleman from north carolina. >> i move to strike the last word. the chair: the gentleman is recognized for five minutes. >> thank you, madam speaker. i rise to oppose this nonsensical pending amendment, the underlying bill, although the underlying bill doesn't do that all. but most of all, to disagree with the remarks of the gentleman from kentucky just now and from other remarks like that that what the republicans have done are not going to affect the people on medicare now or the people who are older than 55, 55 and older. what it does in fact is shift more and more of the cost of health care to people who cannot afford it so that the richest americans will not have to pay taxes, will have to pay -- they'll cut taxes so the richest americans by even more and it will protect insurance company profits and the profits of everyone else in the health care

field who are making profits that are causing american health care to be twice as expensive as health care anywhere else in the developed world. mr. miller: and it -- the arguments and what the republican congress has done in these last few months have made very clear how cynically dishonest everything republicans said about health care in the last two years really was. especially about medicare. when democrats really did try to find a way to get control of costs without affecting the quality, the availability of care, the access to care, the quality of care, all republicans would say, even when it was specifically and narrowly targeted at fraud, they said we were cutting medicare. now we see what they really think about medicare. and now we see how really -- how little they really do understand how important medicare is to the financial security of older americans, of americans in retirement. now, they say it will not affect

you if you're over 55. if you're 55 or older. well, i just turned 58, it's nice to know the republicans care that much about me, by let me tell you, that's not the way it's going to work. so someone 53, just five years younger than i am, well, when i turn 65 i'll qualify for medicare, presumably i'll get medicare. my 96-year-old mother who i visited this weekend, she will get medicare, i feel pretty confident she'll get medicare for the rest of they are life, but when i turn 65 i'll get medicare, the guy who is 53 now, he'll be 60, he'll be paying taxes for my medicare, he won't be getting it, he'll never get it. what he'll get instead is a coupon, a voucher, he'll get an allowance to go buy private insurance and private insurance is simply not going to pay for what medicare pays for. it is going to be far more expensive. the congressional budget office estimates that in just 10 years those folks will have have to pay 60% of their own health care

cost if this plan goes through. what they call a path to prosperity, what should be called the path to insurance company profits. in 20 years it will be 2/3 of their health care costs. they will be paying for it. they'll also be paying taxes or working americans, people who are still in the work force, i will pabbing taxes so i get medicare and they know that's the deal they're getting. the deal they'll be get something that little voucher, that puney little vouch that are puts them at the mercy of insurance companies -- voucher that puts them at the mercy of insurance companies. all of republican politics seements to be built around resentment. i don't to have a nation that filled with resentment between generations. ms. edwards spoke about the contract between generations, that just as our parents took care of us in our childhood, we will take care of our parents and their generation when they retire. we'll take care of them with our social security taxes, our medicare taxes, they will get those benefits. but under the republican plan, the path to insurance company

profits, they won't get medicare, they'll get that little voucher. how long is that going to go on before that resentment builds up? how long is that going to go on before the people are paying the taxes for it and know they'll never get are going to say, no? no more of this. we have got to change this. madam speaker, what we want is for all americans to get the same deal. we want the people who are 65 and people who are 96 to get the same deal, the people who are 70 to get the same deal, the people who are 58 to get the same deal, the people who are 50 and 30 to get the same deal. and if you're willing, if this congress is willing to control cost, even though that means limiting the profits of some of the people who are getting really rich from our dysfunctional health care system, we can do that. i yield back. the chair: the gentleman yields back the balance of his time. the gentleman from rhode island. mr. cicilline: i move to strike the last word. the chair: the gentleman from

rhode island is recognized for five minutes. mr. cicilline: thank you, madam chair. i rise in opposition to the amendment and in defense of our nation's seniors who are really under attack and why is that? because the current republican budget proposal passed by this house and up for senate consideration pulls the rug out from underneath our seniors. it ends medicare by making huge cuts in benefits and putting insurance companies in charge of our seniors' health care, letting insurance decide what treatment and what tests our seniors will receive. under the republican plan medicare will end, will not only impact our seniors, but it limb pact the family members of our -- it will impact the family members of our seniors who are will now have those responsibilities. it will reopen the doughnut hole, making it more expensive for our seniors to get their prescriptions, the prescriptions they need to keep them healthy. and under their plan, they will slash the support for seniors in nursing homes while continuing to give subsidies in the billions of dollars to big oil

companies. and what else? more than 170,000 rhode islanders in my home state rely on medicare and they'll be paying to give additional tax breaks to the wealthiest americans in our country. to make matters worse, the nonpartisan congressional budget office determined that this budget actually adds $8 trillion to the national debt over the next decade because it's can -- its curts in spending are outpaced by the gigantic tax cuts for the richest americans. our seniors cannot afford this republican budget. it would deny them health care, long-term care and the benefits that they've earned. the republicans' choice to end medicare by cutting benefits and turning power over to the insurance companies for the important health care decisions of our seniors will result in reduced coverage and exposure to greater financial risks for our medicare recipients. costing even jors -- seniors an estimated $6,000 more each year

for their care. the congressional budget office determined that under this republican budget, seniors out --' out of pocket -- seniors' out-of-pocket eblings pences could almost triple. they included and i quote, most elderly people would pay more for their health care. to put that into context, the c.b.o. found that in 2030 seniors will pay 68% of premiums and out-of-pocket costs under the republican plan compared to only 25% under current law. and it found that the republican plan means seniors will pay more for their prescription drugs because it reopens the doughnut hole, costing each of the four million seniors who fall into that coverage gap up to $9,300 by 2020. and the conservative "wall street journal" concluded that this plan, and i quote, would essentially end medicare which now pays for 48 million elderly and disabled americans as a program that directly pays those bills. under the guise of deficit

reduction, this republican plan is recklessly attacking vital support systems for our seniors. we all agree that we have to address the deficit. the issue isn't whether we should do it but how we do it. let's repeal subsidies to big oil, let's eliminate fraud and waste, let's end the wars that are costing us more than $2 billion a week. but we should not be balancing the budget on the backs of our nation's seniors. our federal budget is more than just about dollars and cents. it's a statement of our values and our priorities as a country. the republican budget reflects the wrong priorities. they would rather cut benefits to our seniors than cut subsidies to bilirakis big oil or corporations that ship our -- subsidies to big oil and corporations that ship jobs overseas. this breaks the promise we made to our seniors to protect them in their golden years. we must do better for our seniors. medicare has met the health care needs of seniors while providing

them with financial stability for more than 40 years. ending medicare would pull the rug out from underneath the feet of our seniors during their golden years. and i ask my colleagues, if we can't protect our greatest generation, what's next? i yield back the balance of my time. the chair: the gentleman yields back the balance of his time. the gentleman from north carolina. >> move to strike the last word. the chair: the gentleman from north carolina is recognized for five minutes. >> madam chair, i've heard my colleagues give volumes of words here today but i've seen little action. in the four years they controlled the u.s. house, they proposed nothing in the way of meaningful entitlement reform, nothing to preserve social security, nothing to preserve medicare, nothing to improve medicaid and ensure it it's there. mr. mchenry: madam chairman, i ask, where is the plan of these house democrats speaking today?

where's their plan for entitlement reform? i'd be happy to yield. fantastic. i would say -- oh, i'd be happy to yield. where's your plan on entitlement reform? >> does the gentleman favor permitting medicare to negotiate the price of prescription drugs the way the v.a. does and save $25 billion a year? mr. mchenry: reclaiming my time, does the gentleman favor the medicare part d prescription drug benefit that has a lower cost basis than what your colleagues proposed at the time of enactment? reclaiming my time, i would say, they have lots of -- i'm going to finish up here, my friend. i would just tell the chairman that what is missing from this discussion, lots of questions, but little substantive action, no policy proposals to make sure that medicare is there for the next generation.

much less, the end of the greatest generation. i would ask my colleagues to come forward with a substantive plan, not just take up the time here on the u.s. house floor, not take away time from these important amendments that we have under this open rule here on the house floor, i would ask my colleagues to do something real and substantive rather than push us to a debt crisis which their policies and their spending are pushing us towards and with that i yield back the balance of my time. the chair: the gentleman yields back the balance of his time. the gentleman from new jersey. >> i move to strike the last word. the chair: the gentleman from new jersey is recognized for five minutes. mr. andrews: i ask unanimous consent to revise and extend my remarks. thank you, madam chairperson. my friend who just spoke asked us where the plan is to reduce the debt and deficit and if he's here i'd be happy to yield to him but i would ask him to consider these ideas. one, medicare pays more than