a way forward that means state rights are still protected while also protecting seniors' rights to the best health care options available. with that, madam speaker, while i support this rule and why i support the underlying legislation, and that's why i encourage all my colleagues to do the same. with that i reserve the balance of my time. . the speaker pro tempore: the gentleman from florida reserves the balance of his time. for what purpose does the gentleman from florida -- mr. hastings: thank you very much, madam speaker. i yield myself as much time as i may consume. i rise in opposition to h.r. 5 and this bill overlooks the rights of injured patients. but it's also an attempt by the house republican leadership to dismantle the affordable care act.

i will remind my friend from florida that there is no example that allows for any of us to have it both ways. this matter violates the constitution and clearly not just those that argue the 10th amendment from a conservative or liberal perspective, it is all of us that feel very strongly that this measure ewe suches the -- ewe certains the power of states -- usurps of power of states. i'm fond of saying what a constitution law professor at georgetown said, that people seem to be fair weather federalists and they abandon federalism whenever it is

inconvenient to someone's policy preferences. h.r. 5 combines two completely unrelated measures. the first one is the reform of our nation's medical malpractice system. the second one is the repeal of the independent payment advisory board which was established by the affordable care act. please don't get me wrong, i'm fully aware of the challenges inherent to our medical liability system. the excessive cost of malpractice insurance faced by physicians seriously impairs our nation's health care system by encouraging the practice of defensive medicine. this contributes to higher health care costs for both doctors and patients, as well as diminished access to care for consumers. but while i agree that our medical liability system needs to be changed -- changed, i do

not believe that it should be at the expense of the fundamental rights of patients including their ability to seek compensation for wrongful injuries. indeed this bill imposes an arbitrary and unfair cap on noneconomic damages that injured patients can receive. such limitations will extinguish our rights and have a devastating consequence for individuals harmed by physicians and medical products. in addition, this bill seriously encroaches on the 10th amendment of the constitution by preempting state laws and i'm not buying the confusion offered in the rules committee yesterday, nor by my good friend from florida. i know preems when i see it -- preemption when i see it, i know the 10th amendment and i know people have stood for the 10th

amendment and i need not remind my colleague that countless republicans have made statements regarding this particular matter not fitting within the framework of the 10th amendment's commerce provisions. my republican colleagues like to talk about frivolous lawsuits and unreasonably large jury awards. but i ask the question of the maker of this particular provision on what is his leg worth? it's easy for us on the republican or democratic side, liberal or conservative, to be about the business of talking about somebody's harm and then what happens is all of the lawyers that are the bad people of the world, everybody wants the best lawyer when it is them and their problem that is the problem. and i ask the maker of the bill, how much is his leg worth? when you cut off the wrong leg,

who can stand among us and say that $250,000 is enough? so where did that cap come from? it came from a 1978 provision, $250,000, this is 2011, we're moving fast with costs rising. i ask anybody here or that is within the range of this particular measure at this time, please tell me when your health care insurance went down. i don't know of any example, i've been paying health care insurance for 49 years and it's gone up repeatedly during that period of time and i don't care whether that was a republican president or a democratic president. health care costs went up and i don't think that this measure here is going to bring it down. what do you think about the family in chicago whose perfectly healthy baby was born lifeless because the hospital team failed to provide them with proper oxygenation during labor

and to perform an emergency c-section on the mother? the boy is now 5 years old, suffers from permanent neurological damage and is totally dependent on the care of his parents for all his daily activities. you ask his parents if $250,000 is enough for a lifetime of care. oh, no, then you say, thrust it on the state. let medicaid take care of it. and then what you do under the ryan budget, my good friend, is you say, block grant medicaid, and i saw that movie in florida when they block granted medicaid and it was used for everything else other than for poor people. something is wrong with that movie. what about the judge in palm beach county who had a surgical sponge left in his stomach after having abdominal surgery and had to wait five months to have it removed? by then the mass measured more

than a foot long and a foot wide and the rotted part of his intesten had to be removed skfment -- intestine had to be removed. ask him if a lawsuit is frivolous. each case and each injury is different. it is not the role of congress to decide the fate of these individuals and families devastated by malpractice, by establishing arbitrary limits on the financial compensation that they are entitled to. as you all know, the medical malpractice portion of this bill is actually a pay-for meant to offset the repeal of the independent payment advisory board. ipab, as it's referred to around here, is a board of 15 physicians and experts established by the affordable health care act to find ways to control health care costs associated with medicare. under the act ipab will make recommendations to slow the growth rate in medicare spending

if spending exceeds a certain target rate. the congressional budget office estimates that the repeal of ipab would increase direct spending by $3.1 billion over 10 years. $3.1 billion. now is not the time to repeal measures thatty save our nation money -- that can save our nation money and reduce our desit without offering any -- deficit without offering any substitute and that's the takeaway from this. my friends say, don't do ipab and i say to my friends, what do you do? and you do nothing. that's what you do and that's what you've been doing here in the congress since we came here. we have given do-nothing congress a new meaning, rather than dealing with jobs, the things that people are completely interested in, rather than passing the infrastructure measure that the senate has passed that will deal with -- immediately with jobs in america, we are around here

passing a measure and it will pass the floor of the house of representatives, that will go to the senate and go nowhere. so then what ask we do? we did nothing. the congressional budget office also estimates that thanks to the cost-saving mechanisms in place in the affordable care act , ipab will not likely be required to act for the next 10 years. i heard my colleagues just a minute ago say that health care costs have gone up since president obama has been in office. my mom is fond of saying that if we're going to keep pointing back to the other president, if we say now obama says bush did it and bush said that clinton did it and then clinton said that bush did it and bush said that nixon did it and nixon said that carter did it, then we could just point back to george washington and say george washington did it. and get it all over with. rather than continuing this

charade before the people are thinking that somehow or another we have the solution here. health care costs have gone up and they're going to continue to go up until we, as men and women in the house of representatives and the united states senate and the american people sit down and decide that this is a solvable problem which will allow us to address those things that are vital in this country. the bill is a complete waste of time. it does nothing, in addition to going nowhere, it does nothing to help the american people, it contains nothing to improve the affordable and accessibility of health care and repealing ipab, you want to talk about frivolous, that's what frivolous is. let us give the american people what they really need right now and that's jobs. how many times have we -- do we have to say that down here for people to finally get it? frankly i'm appalled by the hypocrisy of my republican colleagues who keep stating that

federal spending needs to be kept under control. but at the first opportunity they wind up rejecting one of the most serious tools in place to actually tackle medicare spending and find ways to make care more affordable. what are the republicans offering to replace ipab? nothing. since the beginning of the 112th congress, the republican majority has sought to repeal as many provisions of the affordable care act as possible. without providing any replacement, listen to that, without providing any replacement and absolutely no long-term solutions. if we do nothing medicare costs will continue to increase. thereby increasing the burden on millions of seniors, disabled individuals and their families all across this country. what is the republican plan? what is the plan?

it is to replace medicare with the new ryan budget introduced yesterday, replace it with some kind of premium something that ain't nothing but a voucher system that would certainly result in increased costs for seniors and reduced benefits. the truth is that the republicans have no plan to reduce medicare and i defy them to present it. if you look at the budget that was released yesterday, it's all filled with blank spaces and i'll fill in the line, nothing, nothing, nothing. so instead of just repealing ipab, let us improve it, reform it or replace it. by doing nothing it's surely not going to fix the problem. i reserve the balance of my time. the speaker pro tempore: the gentleman from florida, mr. hastings, reserves his time. the gentleman from florida, mr. nugent. mr. nugent: madam speaker, i'd like to have my fellow member of the rules committee, freshman,

rob woodall from georgia, and give him three minutes. the speaker pro tempore: the gentleman from georgia is recognized for three minutes. mr. woodall: madam speaker, i very much appreciate that and i thank my colleague on the rules committee for yielding. i want to come down here and talk about the rule, my colleague from florida's just made a very impassioned case for why he is likely going to be voting no on the underlying legislation. if i understood his comments correctly, i'm guessing that it's going to be a no vote after we have finished six hours of debate on this bill. six hours of debate. which is the kind of debate that a bill of this nature demands. and i'm very proud that the rules committee set aside that kind of time. now, i was fortunate enough to have one of my amendments made in order by the rules committee, as was my friend from florida, but a lot of members were not and i wanted to come down here, madam speaker, to speak to the authorizers, the chairman out there, who -- chairmen out there, who are sending this legislation to the floor. because what we have in this house is called the cut-go resume which says if you bring a

bill to the floor -- rule which says that if you bring a bill to the floor that's actually going to do some reducing of the federal deficit, if you're going to be bold enough in this house to send a bill to the floor that's going to reduce the burden that we're placing on our children and grandchildren every day, then nothing that happens on the floor of the house, as we try to amend that bill, will be allowed to reduce that savings. so when a bill comes to the floor as this bill has, h.r. 5, that has a very high cut-go number in it, we're in a box. it cannot be amended with different ideas because those ideas are either not germane, germaneness means that had has to be relevant to the underlying legislation, or they can't cut any additional funds. and so what we had to do in the rules committee yesterday was reject amendment after amendment after amendment that our colleagues offered that we would ordinarily have made in order here on the house floor in what has been the single most open congress that i have seen in my

lifetime, i'm a freshman on the floor of this house, i've been watching this institution, the single most open congress i've seen in my lifetime, but we were not able to make more amendments in order because they were not germane or they violated cut-go. to the rules committee credit, we did not waive cut-go. we complied with the rules of this house. but i say to my friends who are on those authorizing committees, if you want to take advantage of the rules committee, in this congress, that is providing more opportunity for more debate and more amendment and more discussion we have seen in decades, you need to be cognizant when you send those bills to the rules committee that we are not inclined to waive cut-go and rightfully so and we are not inclined to waive the germaneness rules and rightfully so. but that means today we are going to have the narrow discussion that our friend from florida has on the bill, oh, six hours today, and i want to thank my friend on the rules committee for bringing such an

open rule to the floor and bringing such an expansive rule to the floor and providing the kind of opportunity for debate even though i disagree for my friend from florida, providing opportunity for debate, the likes of which america has not seen in decades. and i yield back the balance of my time. the speaker pro tempore: the gentleman from florida, mr. hastings. mr. hastings: madam speaker, my friend from georgia -- and he is my friend -- pointed out that his amendment was made in order yesterday. i might add in keeping with the notion if you can't have it both ways, he'd strike all the findings and it seems to me that's admitting justification for the authority to pass federal tort reform but it directly contradicts the same constitutional arguments will

make next week in front of the supreme court to reform the affordable care act. i'm very pleased to yield three minutes to my very good friend from new jersey, a member of the budget committee, the distinguished gentleman, mr. andrews. mr. andrews: i ask unanimous consent to revise and extend my remarks. the speaker pro tempore: the gentleman from new jersey is recognized for three minutes. mr. andrews: i thank my friend for yielding. whether you're a democrat or republican, liberal or conservative, no matter where you live, i think the number one issue confronting our country is the lack of jobs. it is the central issue of our times, central problem of our times. the american people want us to look forward and work together and solve that problem rather than looking backward and relit gaiting political debates. 195 days ago the president of the united states came to this chamber and set forth a series

of specific ideas to put americans back to work. one of those ideas was to put construction workers back to work repairing and building our roads and bridges, building schools, wiring schools for the internet, putting our construction industry and transportation industry back to work. we're going to spend six hours debating whether to repeal part of the health care bill, again. we're not going to spend six minutes debating a bill that will put our construction workers back to work fixing our roads and bridges. now, the republican leadership of the house is kind of isolated on this because democrats in the other body voted for a bill to put our construction workers back to work, and republicans in the other body voted for the same bill. 3/4 of the senate voted to put our construction workers back

to work. we introduced a version of that yesterday that says let's do that here, but the house republican leadership won't put this bill on the floor. so instead what we're going to do is have one of our recurring debates about whether to repeal the health care bill. now, people feel very strongly about the health care bill, pro and con, but most people feel even more strongly it's the wrong thing for us to be talking about right now. if there's a bill that 3/4 of the senate voted for to put americans back to work, where don't we vote on that here today? instead, what we're going to do is vote on repealing part of the bill that talks about a committee that might or might not take action five years from now to do something the way medicare money is spent. i think if you are in this

country, what would you like your house of representatives to be voting on today? a vote to put construction transportation workers back to work or a bill that will decide whether a body will or won't act five years from now on the way medicare is going to be run? i think we all know the answer to that. the right thing to do is oppose this rule and instead put on the floor the senate transportation bill that 3/4 of the senate voted for. let's approve it. let's put it on the president's desk and let's finally work to put americans back to work. i yield back the balance of my time. the speaker pro tempore: the gentleman from florida, mr. nugent. mr. nugent: madam speaker, i love the hyperbole. i love my friend from florida, his passionate discourse earlier in this conversation. but he was right, you can't have it both ways. and here's the problem. and their idea of having it

both ways, they talk about medical malpractice as if -- if we do nothing, things get better. if we ignore tort reform, things get better. if we ignore tort reform, cost of health care will stay the same. well, in fact, it hasn't. it continues to rise. talk about higher health care costs, but when we talk about that we talk about ipab in particular. 15, 15 unelected bureaucrats. the maximum number that can be on that panel is seven physicians. seven. so they're outvoted already. they're outvoted 8-7 no matter what they think is the proper care for a patient. they're going to be overridden by eight other bureaucrats that have nothing to do with providing health care to our seniors. not a thing. it's all going to be about cost, and they're right.

that's how you're going to contain costs, by removing the options for seniors to get the medical care that they deserve and that they need. this independent panel is a rationing board. it's going to ration health care out because that's the only way that panel can save money for the affordable care act. it was designed that way. it was designed to keep us, the american people that are going to use that service, that medical care, to preclude us from getting it because physicians, when they get their payments cut, will no longer offer service. so where are we supposed to go? that is rationing. that's taking away service from people that need it the most. those seniors that have paid into this system for their lifetime and now are depending upon it to be there when they medically need it the most.

this is about -- this is about the seniors that are in my district. i have 250,000 seniors, a quarter of a million, that rely upon medicare. and if we're going to start rationing care to them, i think it's immoral and it's unethical and it's not the way we should be doing it. we should be doing about free market. we should be talking about tort reform that everybody agrees that tort reform, even the gentleman from florida talked about high cost of medical malpractice insurance. well, where does that come from? doesn't just spring up out of the earth. it comes up for a reason. because the increased cost to provide medical malpractice and particularly for doctors where it drives up the cost of medical care, is that -- that's defensive medical care. that's what's driving up the

costs, along with the premium they have to pay because the lack of tort reform. madam speaker, i reserve the balance of my time. the speaker pro tempore: the gentleman from florida, mr. nugent, reserves his time. the gentleman from florida, mr. hastings. mr. hastings: i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. hastings: i'll be very brief before yielding to my friend from the rules committee . my friend from florida says that he appreciates the hyperbole. i hyperbole on occasion to find that my friend who is taking positions that going to hurt people require everything from hyperbole to passion to try to get the american people to readily understand. and to demonstrate what we are talking about, my friend just stood up and said that the ipab board will be rationing. the statute, if it ever comes

into existence in the future, specifically says that they cannot ration. i don't know whether my friend read that provision or not, but i am pleased to yield one minute to my friend on the rules committee from colorado, mr. polis. the speaker pro tempore: the gentleman from colorado is recognized for one minute. mr. polis: i thank the gentleman from florida. we're in an unusual situation here where the same people on the other side of the aisle who decry the regulation of what insurance providers have to provide to those they insure across state borders who want to interfere with our requirement that insurance companies not be allowed to discriminate based on pre-existing conditions on the other hand say we need to replace the state tort systems, all 50 of them, with one overarching federal approach with regard to malpractice. so whereas there is no federal

role to protecting patients from being dropped by their insurers, from preventing insurance companies from excluding individuals because they had childhood asthma, because they are breast cancer survivor and many cases because they have a child, while there is no federal rule for that somehow there is a federal role in micro managing the way in -- micromanaging the way in one that is botched by a procedure can seek recourse. i ask my colleagues, not only where is the consistency, but how can we reconcile this with our values as americans? i yield back the balance of my time. the speaker pro tempore: the gentleman from florida. mr. nugent: madam speaker, i have to agree with my good friend from florida on one issue and that's with regards to rationing. you're right. it's not in the act, but, you know, if it walks like a duck and quaks like a duck, it's a -- crosswalks like a duck it's

-- and quacks like a duck, it's a duck. there are things that congress can't even touch. this board is going to say, this is the amount of money that we will pay for this procedure. doesn't matter if that's what the procedure costs. doesn't matter that this doesn't cover the cost of the physician. it doesn't matter that what's going to happen are physicians going to refuse to these those patients. madam speaker, that's rationing. call it what you want, that is rationing when you have an independent board that can make decisions in regards to the cost of services that you're going to make or decisions for you to have services by a particular doctor and we see it already today. in my physician's office, it already says we do not take new medicare patients. it's going to get worse, and this board, while it may not call it rationing, and i give them great credit for them not

putting it in the terminology of the affordable care act, it is rationing no matter what you call it. i yield back -- i reserve the balance of my time. the speaker pro tempore: the gentleman reserves the balance of his time. the gentleman from florida. mr. hastings: i yield myself just for a moment. i yield myself such time as i may consume. what you're saying is the ipab board, which may bring down costs, and i might add you just said that congress could not touch it, quoting you. that's not true. congress could change it so long as it stays within the prescribed limits, and that is simply what the law itself says. well, what is the republican plan? as i understand it from mr. ryan's budget offered yesterday, it would be a premium system for medicare. now, you just said that rationing by any other name or you know it when it's a duck and all that kind of stuff, well, a voucher by any other name is still a voucher. and you're going to tell me that's a good system? i yield to my friend.

mr. nugent: well, if you look what the ryan plan says, it also talks about what we currently have today. if you want to keep what you have today in the way of medicare, you keep it. but if you want to go out and buy your own insurance to a select group, you can do it. just like you can today in regards to medicare advantage. but there's a choice that i can make. mr. hastings: i reclaim my time. mr. nugent: i thank you, first of all, for giving me the time. mr. hastings: just to reclaim my time to say that you had it right, select. for example, our governor in the state of florida had one of those select provisions, and he's one of these people that wants us to turn everything over. i had the good fortune yesterday of having the chairman of the blue cross blue shields who thinks that this particular measure is something that would be helpful in his industry. but that's one thing for another day.

madam speaker, if we defeat the previous question, i'm going to offer an amendment to the rule to provide that immediately after the house adopts this rule that it bring up h.r. 14, the house companion to the bipartisan senate transportation bill, and i'm pleased now to yield to the distinguished gentleman from new york, mr. bishop, my good friend, three minutes. the speaker pro tempore: the gentleman from new york is recognized for three minutes. mr. bishop: thank you very much, madam speaker, and i thank my friend from florida for yielding. you know, time and time again over the last several months we have heard from republican leadership. we've heard their talk about the highway bill, h.r. 7, and they've talked about it as their principal jobs bill for the 112th congress. well, here we are, march 21, 10 days before the expiration of the current extension of the surface transportation bill and where are we with respect to this incredibly important jobs legislation? we're absolutely nowhere. as of today house republicans

have yet to put forward a credible highway re-authorization that puts americans back to work. their only steament, h.r. 7, the -- attempt, h.r. 7, the boehner-mica altogether days is, was passed on -- authorization, was passed on february 14. it passed on a party line vote with couple of republicans voting against it. then something happened on the way to the floor. on the way to the floor the republican leadership realized that they didn't have the votes on their side of the aisle to pass it. and what about this bill? well, secretary ray lahood, a former distinguished member of this body, republican from illinois, current transportation secretary, described it as the worst highway bill he's ever seen. he's been in public life for 35 years. the bill was drafted in the dark of night without any underlying, any democratic input. remarkably it removed transit from the highway trust fund. removed the guaranteed federal

funding that's been in place, bipartisan basis, for 30 years, removes it. and it couldn't attract understandably a single democratic vote but they found out on the way to the floor they couldn't get enough republican votes to pass it either. now i'm proud to be offering had the senate bill, map 21, we're calling it h.r. 14 here in the house, and this bipartisan legislation should refocus the discussion on jobs and economic opportunities rather than the republican message this week of tearing down medicare and protecting the 1% at the expense of middle class families. h.r. 14 represents a bipartisan path forward that makes meaningful reforms and provides certainty to states. map 2 is passed overwhelmingly in the senate with a bipartisan majority. as you heard mr. andrews say, 3/4 of the senate voted for this bill. it's fully paid for. something that the house republicans seem unable to come

close -- close to achieving and the h.r. 14 pay fors are less controversial than the pay fors in the house republican bill. it's been sfimented -- estimated that this bill will save $1.-- 1.8 million jobs and create up to one million more jobs. during a weak economic recovery, looking for a jumpstart, why aren't we passing this bill? why aren't we even debating this bill? why are we 10 days away from the expiration of the current extension and there's no plan, underline no plan, in this house to move forward. is h.r. 14 the silver bullet to our transportation needs? no, it's not. can i have an additional minute? mr. hastings: i yield the gentleman an additional one minute. the speaker pro tempore: the gentleman is recognized. mr. bishop: thank you very much. i appreciate you yielding. there isn't a -- isn't a silver bullet when it comes to our infrastructure needs. i and a great many others would prefer a five-year bill. but given the hyperpartisan fashion in which the house republicans have advanced h.r. 7 and some of the deeply flawed proposals included in their bill, h.r. 14 is the only

proposal out there that currently democrats and republicans can stand behind. democrats will not wait around for house republicans to pander to their base and chase ideological extremes. americans want jobs and safe roads and safe bridges. the senate passed the biggest job creating bill in this congress by an overwhelming bipartisan margin, the house has done nothing. let's get this country moving again by passing h.r. 14 so the president can sign it. let's create jobs, let's make it in america and pass this bill. i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from florida, mr. nugent. mr. nugent: mr. speaker, may i inquire of my friend from florida how many speakers he has? mr. hastings: madam speaker, would you advise both of us how much time each has? the speaker pro tempore: the gentleman from florida has six minutes remaining. the gentleman from florida, mr. nugent, has 14 minutes. mr. hastings: i have more speakers than i have time but i

know that during that period of time that i'm going to have at least two more speakers and possibly three. mr. nugent: i'll continue to reserve. mr. hastings: i'm pleased to yield two minutes to the gentleman from oregon, mr. good friend, mr. defazio. the speaker pro tempore: the gentleman from oregon is recognized for two minutes. mr. defazio: repeal and replace, that's what the republicans said they'd do. what's the replacement? apparently it's the ryan voucher plan which will stick it to seniors in the future. not too good of a replacement. but the other thing they're repealing that they don't want to talk about is the repealing restrictions on age discrimination by the insurance industry, they would be repealing the restrictions on pre-existing conditions, to discriminate against people. redline them see lentionly by the insurance industry and they would be repealing the provision of reviewing excessive rate

increases which has been already successful in california this year. so the republicans, you know, have come forward with this one part of the bill, they've already repealed all of obamacare, but now they're going to repeal it bit by bit because they don't want to do real things like deal with our transportation system and that. but there's one particularly objectionable part of this. they're going to pretend that they're taking away the antitrust protection of the insurance industry. remember, this is an industry that can and does get together and collude to drive up our premiums. and just -- after the republicans do away with age discrimination, pre-existing condition and rate increases, the industry's going to have a field day. so they're pretending that they're going to allow suits against the industry for antitrust violations. unfortunately not really. if someone wants to bring a suit, they can't do it as a class action. well, more than 90% of antitrust

suits are brought as class actions. individuals do not have the resources to take on the insurance industry. so they're going to take something that in the last congress was bipartisan, a bill i had to really take away the anti-trust immunity in the insurance industry, give a benefit to all consumers in this country, pass this house by 406-19 and now they're going to fake out they think the american people by pretending they're taking on the insurance industry while they're filling their pocket with contributions from them. good work, guys. the speaker pro tempore: the gentleman from florida, mr. nugent. mr. nugent: madam speaker, i'm a little confused because i thought we were talking about other issues than what the gentleman was just speaking to. particularly about, as it relates to ipab, and about tort reform and i'll be happy to reserve the balance of my time. the speaker pro tempore: the gentleman reserves. the gentleman from florida, mr. hastings. mr. hastings: thank you very much, madam speaker. i'm very pleased to yield one minute to the distinguished

woman from california, my good friend, ms. richardson. the speaker pro tempore: the gentlelady from florida is recognized for one minute. ms. richardson: i thank the gentleman for yielding so that i might speak to the house companion bill of map-21 of h.r. 14 of which i'm a co-sponsor. map-21, which we call h.r. 14 going forward, will generate jobs, repair roads and bridges and invest in our infrastructure. this surface transportation authorization bill passed by the senate by far with the majority and with bipartisan support. i come before you today to urge my colleagues to let's bring this bill forward, h.r. 14, so that we might establish some consistency, unlike what we saw with the f.a.a. re-authorization. consistency for states, for companies, for workers, for projects that need to get done. this bill will maintain current funding levels for highways and public transportation, it will consolidate and streamline highway programs and establish a much-needed national freight

program. this bill will authorize $1 billion for projects of national significance which many of us feel in our own particular districts. h.r. 14 also improves the safety and institutes performance measures and improves accountability for transportation infrastructure investments. will the gentleman yield an additional 30 seconds? mr. hastings: i yield the gentlelady an additional 30 seconds. the speaker pro tempore: the gentlelady is recognized for 30 seconds. ms. richardson: now is the time for swift action by this house on a bipartisan senate bill that will create and save at least 132,000 jobs in my area alone. transportation has always been bipartisan, let's keep it that way in this house and i urge the support of h.r. 14 and i reserve the balance of my time. the speaker pro tempore: the gentleman from florida. mr. nugent: i continue to reserve. the speaker pro tempore: continues to reserve. the gentleman from florida, mr. hastings. mr. hastings: most respectfully i would ask of the speaker to inquire of the gentleman if he's ready to close. mr. nugent: i am ready. mr. hastings: all right. then i'm going to be our last

hyperbole. madam speaker, first would you tell me just how much time i do have? the speaker pro tempore: the gentleman from florida has 2 1/2 minutes remaining. mr. hastings: thank you. that said, madam speaker, i thank my friend for the debate and the time that he's allowed us. i think all of our colleagues who came here -- i thank all of our colleagues who came here. this h.r. 5 is going to be devastating to medical malpractice victims. parents -- patients shouldn't have to pay the price for excessive malpractice insurance. if we want to reform the medical liability system, let us start with addressing insurance costs and physicians' premiums. let us start with finding strategies to reduce and prevent mistakes and crack down on repeat offenders. today 5% of all doctors are responsible for 54% of

malpractice claims paid. let's not start with penalizing patients for injuries due to no fault of their own. let's not give the american people another reason to believe that congress is out of touch. thousands of people die each and every year due to medical malpractice. this is not frivolous. we had 16 of our members come forward yesterday to offer amendments. we're going to have six hours of debate on six, because we in the rules committee have the power to refuse to waive the power to allow those amendments to come in. some that included things such as not being able to allow a child 3 years old who may have a matter that doesn't manifest itself until he or she is 8 be barred because of time constraints. measures that deal with, like the pediatrician in delaware who raped 100 or more children,

babies, and that physician would not be allowed for dish know that one would argue that some lawsuits are frivolous and they are. i am a lawyer. i am a trial lawyer. and so i clearly support the trial lawyers. so that's understand. but when people are dying, that's not frivolous and as i said, people want the best lawyer that they can find. madam speaker, i ask unanimous consent to insert the text of the amendment in the record along with extraneous material immediately prior to the vote on the previous question and i urge my colleagues to vote no and to defeat the previous question. i urge a no vote on the rule and i do so for the reason that this measure does nothing, is going nowhere, will go to the senate and will not pass and everybody in this house knows it. we have to stop doing nothing

and do something for the american people and jobs. the speaker pro tempore: the gentleman from -- without objection, the gentleman's request is so ordered. the gentleman from florida, mr. nugent. mr. nugent: madam speaker, i appreciate my good friend's confession about being a trial lawyer. i'm not. i'm not an attorney. so what i'm worried about is not how attorneys enrich themselves, i'm worried about the people that i represent, 250,000-plus, that are on medicare. concerned about them. i'm concerned about, you know, you hear from the other side, well, don't worry about it, it could be five, 10 years from now. well, you know what? i'm concerned now because why would you have something put in place that's going to ration care to our seniors when they need it the most? that's when they need it the most. we should be advocating for them. not for trial lawyers. we should be here talking about

tort reform to lower the cost. if you look at what california did, they set up a model program. their liability insurance for doctors is lower than the average across the board in the united states. you know, this health care -- this act, health act, is modeled after that. regards to the noneconomic damages, limits on contingency fees for lawyers, big one there, about fair share, about, you know, a proportional -- whoever's at fault is as a proportion of that, referenced to how the claim gets paid out. but, you know, according to the c.b.o., and i heard this talked about before, but you know, will the health care act work to reduce health care costs and lower the deficit? according to the c.b.o. it will. it will be an average of 25% to 30% below what it would be under

current law which is ipab today. 25% to 30% less than what the current law ipab calls for. is this important? i think the relationship between a patient and a doctor should be between a patient and a doctor, not have a middle man called the united states government stepping in between you to say, you know what? we don't think that that service deserves a certain level of payment and by reducing that payment we know that that's thank service is not going to be provided. i truly don't believe that that's where we should be as a government and i certainly don't believe that we should be in between the patient and their physician. and i worry about and i hear this from dox all the time back in my district, that rich, you know what's diagnose to happen? we're just going -- going to happen? we're just going to close our doors. you know, those that are

entering the profession, there's less and less because they're concerned about how they're going to make a living, how they're going to pay back those student loans that they have because they really want to pay it back, they want to do the right thing, but how are they going to do that? if they can't open a practice and if they can't take medicare patients because this board makes the decision to lower the cost of reimbursement? we've seen it already, every time we do doc fix, we have more and more doctors that are in trouble because of the fact that they don't know what tomorrow's going to bring. . and i don't want our seniors to worry about what our seniors are going to bring i don't want to balance the budget on the back of our seniors. that's not where we need to be. you know, as we move along here, the reason i stand here today is because i support and

i'll defend our seniors which is why i support h.r. 5. because it's common sense. like i said, i'm not an attorney, i'm not a lawyer, so i have but one constituency that i worry about at this point on this particular issue and it is this issue. you heard things about transportation and all these things, but this is the pressing issue today in front of us. the issue is about tort reform. the issue is about ipab and repealing ipab so our seniors can have a direct relationship with the physician of their choice. of their choice. and that's the important part. and with that i yield back the balance of my time and i move the previous question on the resolution. the speaker pro tempore: the gentleman yields his time and the question is on ordering the previous question on the resolution. those in favor will signify by saying aye. those opposed, no. in the opinion of the chair, the ayes have it. the ayes have it. the gentleman from florida.

mr. hastings: i ask for the yeas and nays. the speaker pro tempore: the yeas and nays are requested. all those in favor of taking this vote by the yeas and nays will rise. a sufficient number having arisen, the yeas and nays are ordered. pursuant to clause 8 of rule 20, further proceedings on this question will be postponed. pursuant to clause 12-a of rule 1, the house will stand in recess subject to the call of the chair.

it's pretty devastating to our seniors and future seniors and third, we have to meet -- we have to grow this economy and that means and i believe it means making investments in our future. education and infrastructure and new technologies and growth industries. you know, the beginnings of all this. you know, if it doesn't help

the economy, it doesn't grow jobs, if it doesn't meet our obligations and it doesn't reduce the deficit in a fairway i really think it's a failed budget. to me it is. it starts there and it's controversial even on the republican side but for the democrats it's really not where we would go. host: in the "new york times" -- here is the g.o.p. proposal on the left and president obama's proposal on the right. the revenue is the gray line which is below that. according to the g.o.p. proposal, the ryan proposal, there is $241 billion. the president's proposal, $529 billion.

host: and then you could go also one other chart quickly before we get a response which is in yesterday's "wall street journal" -- and this is an op-ed that paul ryan wrote in "the wall street journal." charting the obama and republican budget sorted by the office of management and budget and the c.b.o. the current path, according to this chart, up to 800%, 900% debt as a share of fwpped and the g.o.p. plan brings it back down to zero. is the current path we're on sustainable? guest: we have to reduce the deficit. that is our annual. of course that actually it -- yes. we both agree, democrats and republicans, that we have to tackle this deficit. the question is how quickly. the question is how.

i think the democrats have been very clear that we have committed to spending cuts. we believe those spending cuts have to be in you a aspects of a budget. every part of the federal government can be more efficient and should be. we should demand for accountability, more transparency, more efficiency and we certainly should cut where we can if we believe there is less of a priority and we already agree on that. we agreed to spending caps at one point, $2 trillion over 10 years, and an additional over $1 trillion in, you know, through either sequester or some other way. we've already committed to $3 trillion, and we would do more. the president's budget, and there will be a democratic budget last week, but the president's budget talked about cutting the deficit in half in five years. that's actually in 2014. that's pretty significant. but we also believe that we, again, have to deal with this in two ways.

it can't all be done by spending cuts. every responsible bipartisan commission says it cannot be done without some discussion and revenues. we believe that's true. republicans don't. they will do -- any cuts, deep as they can go, without responsibly considering revenues. and that's on the corporate side and from the wealthiest americans. you know, we had this discussion for the last year. really, can the wealthiest 1% of americans pay a bit more in taxes? they did under the clinton years. it was a really good economy. if you want to make more money. and do it in a way that protects and grows the middle class in this country? we don't do that i don't believe that america will be as strong as it should be. and the other disagreement is, should we be making the kinds of investments that grows our economic competitiveness in a global marketplace, that grows the new technologies, innovative sector, or do we walk away from that? talking about basic research.

talking about making sure that the tax policy in this country and corporate america have not just oil and gas, the sort of traditional industries, but actually helps in the new technologies and new growth sectors. this is a major difference of opinion. i do think there are places where we do agree. we do also agree that we have to tackle a tax policy in this country, that we can simplify. host: what do you think of a 10% and 25% tax and lower the corporate income tax? guest: right, the president has put out a grand scheme on corporate taxes and talking about bringing down to 28%. that that still takes -- that really does eliminate -- does so by eliminating special interest tax deductions and it is -- these are tough decisions in all that. to bring it down to 25%, there are no details in this republican budget. now, again -- some of the

numbers that you proposed, you put up there from c.b.o., are really based on a lot of assumptions without a lot of detail. i think that's a pretty dangerous way to go. we have to have some of the detail. all americans want to see all of their deductions, either for homeownership, for retirement, being able to go to college, they want to eliminate all those for the sake of that kind of cuts? again, we agree lower taxes is a good thing. we like to see some lower rates generally speaking on the corporate side, business side, but, again, we have to do this with some understanding how this would affect growth in the future. so it's -- it's a -- it's a contrast here but i'd be careful about some of the charts without a whole lot of detail coming from the ryan budget. host: well, we want to take some calls. we'll talk about medicare and i'm sure our viewers will as well. but very quickly, the democrats are coming up with their own budget as opposed to using president obama's. guest: well be using the

president's budget. obviously we will do a few tweaks in that as well. it will create a stark contrast, i believe. not on the decision about whether we can bring down and tackle the -- some these major issues, tax reform. we want to do that. we agree on that. but to understand what the republican budget does, it does it all through spending cuts. it ends medicare as we know it. it fails to make investments in growing our economy and economic competitiveness. it really attends to the wealthiest corporations and wealthiest americans and it doesn't grow the middle class. that's a huge concern to us. host: first call for congresswoman allyson schwartz. randy on our republican line. good morning, randy. caller: thank you. i'll try to make my point across and make it brief. thank you for being there. representative schwartz. you know, consistently in the

last three years, at least, the republican budget plans always included medicare reform, that's true. but it included this caveat in that it wouldn't affect anyone that was 55 years and older. yet, the democrats -- and this budget is no different that came from representative ryan the other day. it's no different. yet, the democrats will lie by admission and never mention -- and scare old people to death that medicare reform, as proposed by the republicans, -- that is not true. whereas obamacare will cut medicare immediately, not in its entirety, as much as 40% to everyone right now. democrats i still say lie by omission. will you on air admit that the democrats' proposal on the budget will not affect anyone over 55 years old concerning medicare? i'll take your answer off the air.

thank you. guest: first, let me take the second part first, if i may. when you say we will cut medicare, the fact is we didn't cut medicare, and some of the changes that we made in terms of reducing overpayments to insurance companies under medicare advantage, for example, actually was not a cut to medicare at all. it really did reduce overpayments to insurance companies and we should know that the republican budget does the same. that $500 billion that you want to make sure we don't do or we've been doing in terms of cutting -- is in the ryan budget. and i think that's a good thing for us not to be making overpayments to insurance companies. medicare advantage is still available for seniors. and you know, we did strengthen medicare for current seniors. we -- it's already happening, as you know, we're closing that doughnut hole for prescription coverage for seniors. we eliminated co-pays for seniors for preventative services at 20%.

we've done a lot to strengthen primary care for seniors. all things i know i think seniors are pretty pleased about. the ryan plan would repeal those -- that strengthening of medicare. they would take that away. you would no longer close the doughnut hole. you will no longer have greater access to primary care. in fact, that would happen. . i think it's not a question it will repeal some of the work that we did that's already current law. as you know that's the goal. and as far as medicare for the future seniors, yes. major changes would take place for future seen seasonors. that is true in the ryan plan. once it goes -- should it happen, we are not going to let it happen, it would already weaken medicare for current seniors and of course since the goal on here is to really turn medicare into a voucher plan,

should they be even more worried about the deficit and their willingness to change medicare for future seniors, no question we don't know whether they would actually end up in terms of the age and affect current seniors. let me be perfectly clear, this would weaken medicare for current seniors and it certainly would dramatically change going to a voucher plan for future seniors. third, i'm sorry to make this a long answer. the cuts to medicaid which most americans think is really mostly about for women and children, and it is, but it also pays for both the nursing home care in -- most of the nursing home care in this country and that's our failest seniors. they would block grant that to the states, cut it almost in half over a number of years and dramatically, maybe in devastating ways, affect care to our current seniors as they age. host: paul ryan writes yesterday in the "wall street journal," absent reform government programs designed in the middle of the 20th century cannot fulfill their promises in the

21st century. it is a mathematical and demographic impossibility and we said so. that's from the "wall street journal." what do you specifically know yet what the democrats will be proposing when it comes to medicare, medicaid, and those reforms beyond some reforms? do you have a specific proposal? guest: we passed a specific proposal that's in effect that is moving ahead. and could be very significant in transforming medicare in a way that protects guaranteed benefits. again, one of the significant differences here between the republican proposal and where democrats are, is the republicans would no longer guarantee benefits and coverage for seniors. it would give you a voucher and say you go buy it in the private insurance system. we are not going to guarantee benefits anymore. you want additional benefits, you got to pay for it. as an individual senior. don't have the strongest negotiating power by the way as a senior.

may have some pre-existing conditions, you might be pretty ill. insurance companies are not anxious for your business in that regard. it's very risky. but what we have done instead is just say, let's deal with the issue of rising costs. it is not possible for us to continue to pay the levels of increaseed cost in health care. we have to deal with the underlying cause of those health costs. republicans don't tackle that at all. they say basically you're on your own. buy it from the insurance industry. get what you can get. the extra cost is on you, maybe up to $6,000 on individual senior and rising. we do inted we say we want to transform the way we pay physicians and hospitals and health institutions to really demand more value for our dollar. to make sure that they are providing more coordinated care, providing necessary care, reducing errors and readmissions to hospitals. these are not small changes.

we are really pushing the health care delivery system in this country which is inefficient and fragmented in too many places to be more efficient, to be more coordinated, to get the right kind of care to our seniors, really to all of us, thrick those with really chronic diseases, serious chronic diseases. let's do a better job, improve quality. let's save lives, dollars, we are talking about billions of dollars in savings. we are already on that path and understand with the republican budget they would undo all of that important work that's happening right now. to get us to a place where all americans can see cost containment not just in medicare but across the health care system. host: next call for congresswoman allyson schwartz comes from kalamazoo, ralph is a democrat there. go ahead. caller: i just wanted to comment -- remind people about the overspending under the bush administration. and the -- paul ryan's votes

during the bush administration that completely obliterated the surplus, the clinton surplus. paul ryan voted for the iraq war. he voted for the -- both rounds of the bush tax cuts. paul ryan voted for the expansion of the medicare part d which was unfunded, which increased the deficit. and paul ryan voted for the tarp, the troubled asset relief program in 2008. so it boggles my mind that paul ryan is considered a budget expert when he under the bush administration did just basically blew the deficit, national debt right out of the roof. guest: let me say this is not just about paul ryan. this is a republican budget. and the republicans voted for it. almost every one of them. they'll vote for it again. and that vote for the republican budget, going to be voted on

today in the budget committee, and voted on the floor potentially next week f. they can reach agreement on the republican side, there is still disagreement there, but it is -- the -- the republican budget does pretty serious damage i have been talking about in terms of medicare and every republican will be held to account, as we all are, for our votes, but in this case certainly i hope the american people understand that again as democrats we are committed to deficit reduction. we believe that should be done in a balanced way. we believe that tax reform should be done in a way that respects and strengthens the middle class. and that we have to make the kind of investments that all of us care about for ourselves and our families and yes, we have to protect medicare. there are changes we have to make in the delivery system of payment reform. we have to reduce the rate of growth and cost across the health care system. we are at a very challenging time in this country. we want to grow this economy and we are going to see a republican budget that many of us feel is

not the way to meet these challenges and to be the strongest economy in the world as we move forward. host: steve an independent in lansing, michigan, you're on the "washington journal." caller: thank you. yeah, my question is pertaining to the budget control act that the senate put out last september that was signed in by both houses and basically paul ryan actually said that it's not the best deal, but 60% kind of went their way on tribal rules, whatever. what they wanted. and this is kind of how i'm looking at it. this supposedly the budget control act which is in law. i don't know why paul ryeian is coming up with another budget for 2013 when -- this budget was a two-year budget. it was supposedly trying to eliminate any political argument pertaining to going into the

election, and another year after that that whoever took office that it wouldn't be another political issue after whoever did take the presidency. but -- so what is this paul ryan budget pertaining to budget control act, which was signed last year? host: i think we got your point. guest: thank you. actually you are following this. let me just say that, yes, there was agreement, house republican leadership and the white house and the senate and they said, all right, we are going to agree on the spending caps we agreed to, but really on what the number would be in terms of how much more we would cut the deficit. the agreement was a little over $1 trillion. $1.048 trillion. that was agreed to. more than a handshake. we voted on it. what we have to do,

appropriations bills for next year, not this year, the agreement was, you're right, we would not have another cliff. we would not create that sort of drama and angst and potentially shut down of government. we would agree on what those numbers were going forward. and yes, you're right. paul ryan and the republicans have already reneged on that agreement. they said the $1.048 trillion is not enough. they want to reduce it to $1.02 trillion. reduce it a bit more. of course the republicans are saying that's good enough. we should go under $1 trillion. agreement, passing law isn't good enough. that creates a bit more anxiety and difficulty in what is already not an easy time to get things done. to grow this economy, create some stability, americans, whether republicans or democrats or independents, they want us to get things done. they want us to find that common ground. we reached agreement.

think we should stick with that agreement and not begin to play with reducing those numbers by another $10 billion, $20 billion, $40 billion. that creates a lot of uncertainty. not good for our economy or us being able to find that common ground. allyson schwartz just said, "the new york times" lead this morning. the careless house budget. "the new york times" writes worst of all it undermines a hard fought agreement democrats and republicans made last august to set spending targets for 2013 under pressure from house conservatives, mr. ryan cut nearly $20 billion from spending levels set in the debt ceiling pact breaking faith with the senate, foningsly leading to a government shutdown this fall. much of that reduction is likely to come from programs like head start, pell grants for college students, and state aid. three very quick tweets that have come in. this is shorty, future generations will do without social safety net in old age if they don't fight for it now. fire this guy. meaning paul ryan, i believe.

stop the spending, raise the taxes. and finally, matt smith says, the best thing we can do for the deficit is grow the economy. the best thing to spur growth, government spending. next call for allyson schwartz comes from california. valley, republican line, you are on the "washington journal." val? all right. time to move on to sarasota, florida. gordon, independent line. hi. caller: hi, good morning. how are you doing? host: go ahead with your comment or question, sir. caller: we are presented -- my congressperson is a car salesman. what's your educational and work experience background to make the comment that you can't balance the budget by cutting spending? that doesn't really hold any weight with me.

and secondly, you made in one sentence you said the republicans want to balance the -- reducing benefits to the seniors, and in the next breath you stated that we can't sustain the current health spending. which is it, thank you? host: who is your congressman, gordon? guest: let me say that first of all we have already agreed that we should cut spending. that's not the question. we have agreed. certainly i feel strongly to reduce the deficit. we have to do it in a balanced and responsible way. and the same thing about the issue of health care in this country. i believe we start with a promise to our seniors. when we pass medicare, a lot of controversy about it then, certainly republicans have been concerned about it -- its whole

existence. i believe we start with the promise of medicare to our current seniors and future seniors. what that means is guaranteed benefits and beneficiaries being able to count our seniors being able to count on medicare. how we contain the rate and growth and cost, that's the question. so it's not at all inconsistent for me to say i want to protect medicare and i want to be able to contain that rate of growth and cost so it is sustainable. that's very different from what we are hearing on the republican side. the republican side is saying the only way we can maintain medicare, any commitment to medicare, is to walk away from it. to say basically, you know what, priority is, government's got to cut spending. it's on you. individual senior, i don't care how sick you are, frail you are, are you going to have to pick up the difference in terms of rising rate of growth and costs. that's a problem to me. i think we should take that responsibility in pushing the health care system to really contain the great of growth and

cost and help make sure that we can sustain it. start with that promise, it starts with the promise to seniors in this country. host: allyson schwartz spent about 14 years in the pennsylvania state senate before being elected to the congress four terms ago. she has a masters from brin mawyer. what's your masters in? guest: social work. i worked in the health care sector. i ran a health center. so i was responsible for budgets and payrolls and figuring out how to make ends meet. in the state senate, states are required to balance their budget. i feel strongly about the need to be fiscally responsible and to be sure we should pay for all we spent in this country. we have come out of a very difficult economy. everyone should understand that. deficits did grow under a previous president. we inherited a terrible economy. it's taking a growth out of that

terrible recession we were in. want to see grow faster. we want to be strong as an economy. we need to do that. and i would like to see us move towards a balanced budget. it is really important to me that we continue to tackle the issue of spending and deficit. but every responsible bipartisan commission has said, we can't simply do it by spending cuts. we have already agreed to $3 trillion in spending cuts. the president's budget has $5 trillion in spending cuts. this is serious business. these are painful decisions for us. willing to make some of those tough choices. but it's also not fair to americans to say taxes, between taxes on our wealthiest americans, pay a bit more. getting rid of tax breaks for the big oil and gas companies. making a lot of money. are no longer necessary. let's tackle this, these issues

about truckses for special interests and reduce the corporate tax rate. that's important, but we really need to do it in a really balanced and fair way. otherwise what we are going to do and what the ryan republican budget does it really protects tax breaks for the wealthiest corporations in america for the backs of the americans. host: ruth of ohio -- >> follow this online at our video library at c-span.org as today's markup session of the budget committee. the house gaveling back in for a series of votes. 591 if ordered, suspending the rules, concurring to the senate amendment to h.r. 886 and agreeing to the speaker's approval of the journal, if ordered. the first electronic vote will be conducted as a 15-minute vote. remaining electronic votes will be conducted as five-minute votes. the first electronic vote will

be agreeing to the previous question on h.res. 591 on which the yeas and nays were ordered. the clerk will report the title of the resolution. the clerk: house calendar number 119, house resolution 591, resolution providing for consideration of the bill h.r. 5, to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. the speaker pro tempore: the question is on ordering the previous question. members will record their votes by electronic device. 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 231. the nays are 179. one voting present. the question is on adoption of the resolution. as many as are in favor signify by saying aye. those opposed will say no. in the opinion of the chair, the ayes have it. >> mr. speaker. the speaker pro tempore: the gentleman from massachusetts. mr. mcgovern: on that i ask for a recorded vote. the speaker pro tempore: a recorded vote is ordered. those in favor of a recorded vote will rise and be counted. 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 --

the speaker pro tempore: on this vote the yeas are 233. the nays 182. one answering present. the resolution is adopted. without objection, the motion to reconsider is laid upon the table. the unfinished business is the vote on the motion by -- of the gentleman from ohio, mr. scifers, to suspend the rules and concur in the senate amendment to h.r. 886 on which the yeas and nays were ordered. the clerk will report the title of the bill. the clerk: h.r. 886, an act to require the secretary of the treasury to mint coins in commemoration of the 225th anniversary of the establishment of the nation's first federal law enforcement agency, the united states marshals service. the speaker pro tempore: the question is will the house suspend the rules and concur in the senate amendment. 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 409. the nays are two. two answering present. 2/3 having responded in the affirmative, the rules are suspended, the senate amendment is agreed to and without objection the motion to reconsider is laid on the table. pursuant to clause 8 of rule 20, the unfinished business is the question on agreeing to the speaker's approval of the journal which the chair will put de novo. the question is on agreeing to the speaker's approval of the journal. so many as are in favor signify by saying aye. those opposed, no. in the opinion of the chair, the ayes have it. >> mr. speaker, on that i ask for the yeas and nays. the speaker pro tempore: the yeas and nays are requested. those in favor of taking this vote by the yeas and nays will rise and be counted. a sufficient number having arisen, the yeas and nays are

ordered. this will be a five-minute vote. members will record their votes by electronic device. [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 308, the nays are 101. three answering present. and the journal stands approved. for what purpose does the gentleman from indiana rise? >> mr. speaker, i rise today to ask unanimous consent that i be removed as a co-sponsor on h.r. 3697. the speaker pro tempore: is there objection? without objection, so ordered.

for what purpose does the gentleman from missouri rise? mr. clay: mr. speaker, i ask unanimous consent to have my name removed as co-sponsor from h.r. 3359. the speaker pro tempore: is there objection? without objection, so ordered. for what purpose does the gentlelady from texas rise? ms. jackson lee: mr. speaker, on h.res. 591, roll call vote 119, i was detained on official business and i would like to indicate that i would have voted no on h.res. 591, the rule to h.r. 5. i ask unanimous consent that it be placed appropriately in the record. the speaker pro tempore: without objection, it will so be noted. jackson scrax jackson thank you -- ms. jackson lee: thank you. the speaker pro tempore: for what purpose does the gentleman from michigan rise? >> mr. speaker, i would ask

unanimous consent that all members may have five legislative days to revise and extend their remarks and -- on the legislation and to insert extraneous material on h.r. 5. the speaker pro tempore: is there objection? without objection, so ordered. the gentleman from michigan. >> mr. speaker, i would -- we are now -- i would ask for order. the speaker pro tempore: the gentleman from michigan. the gentleman from michigan.

the speaker pro tempore: the chair declares the house in the committee of the whole on the state of the union for the consideration of h.r. 5. the chair appoints the gentleman from georgia, mr. westmoreland, to preside over the committee of the whole. the chair: the house is in the committee of the whole on the state of the union for consideration of h.r. 5 which the clerk will report by title. the clerk: a bill to improve patient access to health care services and provide improved medicare care -- medical care. the chair: pursuant to the rule, the bill is considered read the first time. general debate shall be confined to the bill and amendments specified in house resolution 591. it shall not exceed six hours equally divided among and controlled by the respective chairs and ranking minority

members of the committees on energy and commerce, the judiciary committee and ways and means. the chair recognizes the gentleman from michigan, mr. upton. mr. upton: thank you, mr. speaker. i would yield myself as much time as i might consume. the chair: the gentleman is recognized. mr. upton: mr. speaker, i rise today in support of the path act which addresses two of the most glaring deficiencies in the president's overhaul of the health care system. by what it does, it also -- and also by what it fails to do, the health care law threatens access to qualt quality health care for literally millions of americans. section 3403 of the affordable care act established the independent payment advisory board or ipab, a panel of 15 unelected, unaccountable bureaucrats will be given the power to make major decisions regarding who goods and services are valuable. these decisions would then be fasttracked, essentially bypassing the legislative

process, with almost no opportunity for discussion or review. the path prevents -- the path act prevents this by repealing ipab. i suspect that most americans still believe that patients and their doctors should have a voice and should be able to decide what health care services that they find valuable. and i think they still believe that major policy decisions affecting the medicare program and the health care system in general need to go through the regular legislative process and be subject to the normal system of checks and balances according to the constitution. it is encouraging that the co-sponsors of legislation to repeal ipab includes 20 democrats and that the bill was favorably reported out of the energy and commerce committee earlier this month without any recorded opposition. a voice vote. i encourage my colleagues on both sides of the aisle to support repealing ipab and not to block its passage at the

expense of our seniors in the blind effort to support the president's signature legislation. the legislation today also includes reforms that will actually lower the cost of health care, a glaring emission in -- omission in the president's hate care law. the health care law failed to provide any meaningful reform to the medicare system which is one of the largest cost drivers -- drivers of our health care system. the current system is responsible for as much as $200 billion a year in unnecessary spending on defensive medicine. it fails to compensate injure theed patients and it threatens action to quality health care by driving good doctors out of high-risk specialties such as objects tretics and neurosurgery. according to the c.b.o., these commonsense reforms will reduce the federal deficit by $48.6 billion over the next 10 years. so, how have opponents proposed

to fix this present system? they want to spend more, $50 million in grants for state demonstrations is called for in the health care law is not a solution. it's an abdication of responsibility. the president promised to look at republican ideas for medical liability reform, passing this legislation is the very first step towards allowing the president to make good on that promise. so health care decisions should be made between a doctor and a patient. that relation doesn't work when bureaucrats and trial lawyers come between them. so i urge my colleagues to vote in support of this legislation and i reserve the balance of my time. the chair: the gentleman from california is recognized. mr. waxman: mr. chairman, i yield myself as much time as i may consume. the chair: the gentleman is recognized. mr. waxman: mr. chairman, i rise in opposition to h.r. 5. it combines two very bad ideas into one terrible bill that is

anti-senior, anti-consumer and anti-health. it's no accident that we're considering the legislation during the second anniversary of the affordable care act. because this is a thinly veiled partisan attempt to confuse the public and obscure the law's success in covering young people , reducing costs for seniors and providing improved health benefits. title 1 of the bill before us, the medical malpractice provisions, have been around for over a decade. they have not been enacted under democratic or republican congresses and presidents. because they are an extreme intrusion on the authority of the states to set their own liability rules and would shield bad actors from accountability when they cause injury and death

. let's be clear. this bill is much broader than traditional medical malpractice legislation. it protects manufacturers, distributors, suppliers, marketers, even promoters of health care products. and it gives them protection even if they intentionally cause harm. insurance companies and h.m.o.'s are protected as well. the bill shields drug and device manufacturers with complete immunity from punitive damages no matter how reckless their conduct. so long as their products were at one time approved by the f.d.a. this bill preempts state action in an area that has traditionally been left to the states. to the extent that we do have a medical malpractice problem in this country, it should be

addressed at the state level. but this bill not only strips away state law, it puts in place a federal scheme that will not reduce medical errors, will not award appropriate and adequate compensation when an injury occurs and will not lower health care costs. the second part of the bill would repeal the independent payment advisory board or ipab which helps keep medicare costs under control if they rise more than anticipated. ipab's role is to recommend evidence-based policies to improve medicare without harming patients. repealing ipab is the height of hypocrisy.

the main republican attack on medicare and the affordable care act is that we cannot afford them. house republicans are proposing changes that would destroy medicare because they say taking care of our seniors just costs too much. and yet today they will vote for a bill that eliminates one of medicare's cost-saving innovations and saddles medicare with over $3 billion in unnecessary costs. it's no wonder that the public holds congress in so little regard. the republican master plan for medicare is to end the guarantee coverage and shift more costs onto seniors and people with disabilities. they don't hold down the costs, they simply shift them on to seniors and disabled people, onto medicare to pay more for it

out of their own pockets. this is part of the republican assault on medicare. it would repeal the backstop in medicare that keeps medicare affordable for seniors. i want to be clear about what the ipab is and what it isn't. the board is explicitly in statute prohibited from rationing. it also is prohibited from making recommendations that increase costs to seniors or cut benefits. ipab also doesn't take away the role of congress. ipab makes recommendations but congress can and should act on those recommendations. we hear a lot about these unelected bureaucrats. let me tell you, and this place there are a lot of elected bureaucrats. . here's the difference between the democratic approach and

republican approach to medicare. democrats in congress are committed to preserving medicare and protecting seniors' benefits. republicans have proposed ending medicare's guarantee of coverage so they can pay for tax breaks for oil companies and millionaires. let me underscore that. they want to take money out of medicare so they can give more tax breaks to billionaires and oil companies. like some of my colleagues, i have concerns about some aspects of the ipab. i don't agree with the premise that we need ipab to make congress do its job, but no one should think that the hyperbole of ipab republican's rationing, faceless bureaucrats, pulling the plug on patients, that came from their propaganda word

masters. house republicans are voting to repeal the independent payment advisory board because they simply want to eliminate medicare. they want to provide vouchers instead of benefits. they want to shift costs to the beneficiaries. they want to put medicare into a death spiral and leave insurance companies in charge of seniors' care. then, it would be the insurance companies who could then ration care, cut benefits and according to the congressional budget office, likely increase out-of-pocket costs by $6,000. does anybody doubt insurance companies ration care? try to get an insurance policy if you have a previous medical condition. they won't even cover you. or they charge you so much you can't afford it. is that what we want, let the insurance companies make these decisions for our seniors and disabled people?

h.r. 5 is a partisan assault on medicare, an assault on patients who are injured by careless doctors and drug companies and an assault on states' rights. i urge my colleagues to vote no on h.r. 5, and i reserve the balance of my time. the chair: the gentleman from michigan. mr. upton: i would yield to mr. barton, the gentleman from texas, two minutes. the chair: the gentleman from texas is recognized for two minutes. mr. barton: i thank the distinguished chairman and would ask unanimous consent to revise and extend my remarks. the chair: without objection, so ordered. mr. barton: thank you. we have just heard an argument from one of the authors, if not the chief author of the new health care law, so it's understandable that former chairman waxman would rise in -- indignant defense of his product and oppose this bill. but h.r. 5, the path bill, is

in act walt a ration -- actuality a response to reform the affordable care act. the independent payment advisory board is an independent 15-member panel appointed by the president unless the president doesn't appoint it unless three of the president's chief advisors become the board, and if they don't decide to do it then one person, the secretary of health and human services, has the authority when this kicks in in 2014 to make all kinds of decisions that the recognize ream impact health care in america. i don't think and a majority of my colleagues don't think it's the way it should be done, so this bill in one paragraph at the -- i think on page 24, repeals that section. that is a good start. it is not the end-all be-all

but it's a good start of regaining control of health care by individuals in the marketplace. the other thing it does is put in a medical malpractice reform that is long overdue. the president in the state of the union said he was for medical malpractice. i am told he said he's not for this medical malpractice. just like he's not against the keystone x.l. but he calls senators to oppose it when it came up in the other body. we need medical malpractice reform. independent observers have said that this bill that congressman gingrey of georgia is the original sponsor of would save $48 billion over i think a 10-year period if enacted. $48 billion. that's real reform. it does not preempt states. it allows the states to continue their parts of medical malpractice that they already enacted. so i ask that we vote for this piece of legislation and thank the chairman and the

subcommittee chairman and all the members that made it possible. the chair: the time of the gentleman has expired. the gentleman from california. mr. waxman: mr. chairman, i'm pleased at this time to yield three minutes to the distinguished real estate and soon-to-be chairman of the health subcommittee, the gentleman from new jersey, mr. pallone. the chair: the gentleman from new jersey is recognized for three minutes. mr. pallone: thank you. thank you, chairman waxman. you know, i have a great deal of respect for my former chairman and colleague from texas, but the problem that i listen to him is that it's always the same. it's my way or the highway. and it's very unfortunate because there have been many opportunities in the committee where we could have worked together and come up with legislation on things like malpractice reform and ipab, but that's not what we get from the republican side of the aisle. they just constantly want to do their own thing and as he said, the president may be for malpractice reform, but if he's not for this malpractice reform then he's a bad guy.

that's the point. we need to get together. if we are ever going to accomplish anything we need to get together and i don't see that on the republican side of the aisle today. i am very disappointed in the process of considering h.r. 5. i am disappointed and frustrated that my republican colleagues had the opportunity to bring to the floor that i and some of my democratic colleagues supported but what they decided to do instead is simply play political games, political games over and over again. all sectors of the health care industry agree that the independent payment advisory board, ipab, should be repealed. i'm the first one to tell you how much i am opposed to ipab. in fact, during the energy and commerce committee subcommittee on health markup i voted in favor of its repeal. but unfortunately, my republican colleagues have no interest in truly repealing ipab. they only care about defacing the affordable care act and continuing their political game of repealing the law piece by piece. now, i know that because they've decided to pay for the ipab repeal with h.r. 5, one of

the most controversial and historically partisan bills of the past decade. we've been through the same debate every time, every year, h.r. 5 on the floor again. each year the republicans have been in charge, we're forced to consider identical legislation that contains the exact same areas in which we remain divided. in fact, the republicans were not enable to enact this bill into law when they had the majorities in the house and senate and presidency and the reason is because they have zero desire to solve the problems of this country. all they're interested in accomplishing is a political message to take home to their districts. i've said again and again i will work with my colleagues in truly addressing malpractice reform but those calls have gone unanswered. there has been little effort on the part of the republicans to reach across the aisle and work with democrats on a satisfactory solution to medical liability reform. i do understand that medical malpractice and liability is a very real problem for doctors in my home state and in the country but h.r. 5 is not the

answer. any true reform must take a balanced approach and include protections for the legal rights of patients and be limited to medical malpractice. today, my vote on this package is a no vote on h.r. 5 alone. as i've stated, it's too controversial and extreme in its current form, although it's described as a medical malpractice measure, h.r. 5 extends far beyond the field of malpractice liability. i'm just extremely disappointed. i'm being honest in saying i am very disaopponented that the republican leadership has robbed many democrats of their ability to vote cleanly on ipab repeal and have instead yet again politicized this body. when will you learn? i yield back. the chair: the time of the gentleman has expired. the gentleman from michigan. mr. upton: mr. speaker, i'd yield two minutes to the gentlelady from north carolina, the vice chairman -- chairwoman of the energy and commerce committee, mrs. myrick. the chair: the gentlelady from north carolina is recognized for two minutes. mrs. myrick: thank you, mr. chairman. mr. speaker, this is washington

so we have to have an acronym for everything up here. the ipab isn't a new techy technique but an example of one of the many misguided parts of the budget-busting health care law. what's this debate really about? we all know that medicare's headed toward financial catastrophe, and the health reform law only succeeded in putting the program in a more precarious position. there's no easy solution to this problem but republicans have put forward a plan that would actually set the program on a healthy fiscal path again without hurting those who are already on the program. of course, because this is washington, rather than having a hardy debate, these proposals continue to be demagogued and derided. instead, the health reform bill gave us ipab, an unaccountable bill taxed with limiting procedures and treatments in order to control costs. it's a topdown, unconstitutional, ineffective and inefficient way to solve medicare's fiscal problems.

and if you think this board won't make recommendations to limit the use of expensive but life-sustaining treatment, you haven't been paying attention. but here's something that gets lost in the debate. ipab just doesn't apply to medicare beneficiaries for seniors who are on government programs. first off, those of us who have been here for a while know that private insurers tend to follow medicare. we see it all the time. once medicare changes treatment, those decisions push private payers to also move in that direction because so much of our health care system relies on medicare's policies. the government already controls so much of our health care system, and that's why all these inefficiencies abound. if that weren't enough, starting in 2015, the ipab can make decisions about what private plans will cover. yes, 15 people will be deciding

what private companies will be covering. that's what's fundamentally wrong with the health care reform law, and we should repeal the whole thing. but in the meantime, let's repeal this ill conceived board and address the country's medical malpractice problems while we're at it. the chair: the time of the gentlelady has expired. the gentleman from california. mr. waxman: mr. chairman, i'm pleased to yield to an important member of our committee, the gentleman from texas, mr. green, for two minutes. the chair: the gentleman from texas is recognized for two minutes. mr. green: thank you, mr. speaker, and i thank my colleague and ranking member on our energy and commerce committee. i rise in opposition to this bill. i'm not as opposed to all of it. in fact, i am a strong supporter of the repeal of the ipab provisions. however, we can't undermine americans right through court placing arbitrary limits on malpractice cases. that's what this bill before us does. it -- we shouldn't solve a bad policy problem by implementing more bad policy. we should be passing good

legislation, not trying to pass something that has no chance of becoming law and that's what this bill does. the affordable care act, the underlying statute of this bill, has had enormous positive impact of the constituents i represent. in the law it's not totally effective yet but it's getting better. i was proud to support this landmark legislation as part of the energy and commerce committee and on the health subcommittee. before the passage of the affordable care act, our congressional district had the largest percentage of uninsured than any district in our country. we still have a lot of work to do but things are getting better. for the last two years, 53,000 children in our district can't lose the security offered by health insurance due to pre-existing conditions. 3,400 seniors saved an average of $540 on prescription drugs. 9,000 young people now have health insurance that they didn't have before the affordable care act. the affordable care act is not perfect but no bill is perfect. the bill before us today is far from perfect. i support the repeal of ipab.

i opposed ipab in 2009 when it came up in our committee and markup of the affordable care act. i do not believe a panel of outsiders appointed by the president should take responsibilities for what congress needs to do in making decisions on medicare payment rates. that's part of our job as a member of congress. however, this bill has stepped too far, and i want the opportunity to vote on freestanding ipab repeal but i can't vote on h.r. 5 because it's a bridge too far. thank you. i yield back my time. the chair: the time of the gentleman has expired. the gentleman from michigan. mr. upton: mr. chairman, at this point i yield two minutes to the gentleman from florida, mr. stearns. the chair: the gentleman from florida is recognized for two minutes. mr. stearns: i thank the distinguished chairman. this bill, contrary to the gentleman from texas said, is an opportunity for him to vote to not let bureaucrats make the decision. he has a chance to do this. i'm a little surprised why he's saying he's against the bill.

i think many of us will repeat the same arguments. the fundamental point is this bill will save almost $50 billion over 10 years. now, how many people on this side don't want to save money? i think everybody on both sides of the aisle would like to save money. so this is really stopping this defensive medicine an untold amount of litigation by passing this bill. this could effectively create premiums for everybody and lower the cost of health care. this bill would eliminate the independent payment advisory board, it's given the colonial name of ipab. just this morning as chairman of the oversight and investigation committee, we held a hearing on the president's failed health care law. it's clear that countless pages of regulation, rules, requirements for obamacare have been incredibly confusing. and when we had this hearing it was brought up clearly that this bill over two years has given

almost 1,700 waivers to entities who cannot comply with this health care bill. so my constituents and individuals throughout this country who view these massive new rules and regulations as increasing interference of the federal government into their lives. and obviously business communities, they're seeking waivers, 1,700 entities asking for waivers because they can't comply. it creates uncertainty in the marketplace. so, for all these reasons we need -- must pass this bill. in fact, ipab is s.g.r. on steroids. rather than fixing the s.g.r. problem in the health care law, democrats are happy to allow continued cuts to physician payments and then double down on further cuts through ipab. this is a group of 15 unelected bureaucrats who would save medicare by making draconian cuts to provider paymentless. democrats wanted to control -- payments. democrats wanted to control the future costs of medicare by giving unelected bureaucrats the authority to cut payments to

doctors and hospitals. if democrats are serious they would support this bill. ms. pelosi: said we have to -- nancy pelosi said we have to pass this bill to find out what's in it. i'm determined to make sure we don't have to fully implement the bill so we can see what it costs. with that i yield back. the chair: the gentleman's time has expired. the gentleman from california. mr. waxman: mr. chairman, i'm always amused when i hear people talk about government interference in our lives. if people think medicare is an unjust government interference in their lives, they can forego their medicare. but i don't know too many people who would like to do that and what the republicans are proposing is to take that medicare away from them and turn it over to private insurance. put that to a vote. i don't think the american people would support that eater. i'm pleased at this time -- either. i'm pleased at this time to yield to a very important member on our committee, especially in the health committee, the representative from the virgin islands, mrs. christensen, for two minutes. the chair: the gentlelady from the virgin islands is recognized for two minutes. mrs. christensen: i thank you

for yielding. mr. speaker, i rise today in a time when we should all be celebrating the many great successes of the affordable care act on its second anniversary. democrats have rightly been applauding the health can canned -- the health and economic benefits of affordable, reliable access to high quality health care services brought about by that landmark law. not so with our republican colleagues who choose to ignore or misrepresent the many benefits millions of people have been enjoying because of the affordable care act. then comes this disastrous marriage between two bills. one that will repeal the independent payment advisory board with some -- which some democrats like myself support and the other malpractice bill which i strongly oppose because it will trample states' rights, providing extraordinary protections for drug and medical device and health insurance companies, making it nearly impossible for those harmed to seek an achieved justice. i support the ipab repeal because in its current form it will not achieve significant savings or ensure quality access to health care under medicare.

additionally, a physician who practical -- as a physician who practiced for more than two decades, i'm opposed to its broad authority to make recommendations that would detrimentaly affect health care providers and eventually the medicare beneficiaries. however attaching at the very last minute a medical malpractice bill that provides protection to every entity involved in medical malpractice and health care lawsuits except the victim is just plain wrong. and no pun intended but adding insult to injury is the fact that the medical malpractice bill is completely outdated. the bill was designed more than two decades ago. back then we zr challenge with magazine -- we did have challenge with malpractice insurance but those challenges have been addressed. today we do not have a crisis in this country. i strongly oppose h.r. 5 and encourage my friends on the other side of the aisle in the future, if it's more than just political rhetoric, to quit while they're ahead. thank you and i yield back the balance of my time. the chair: the gentlelady's time has expired. the gentleman from pennsylvania.

mr. pitts: at this time i yield to dr. burgess. the chair: the gentleman from texas is recognized for two minutes. mr. burgess: i thank the chairman for the recognition. mr. speaker, i will focus my remarks on the independent payment advisory board because it encompasses all that is wrong with the affordable care act. the health law itself contains policies that will disrupt the practice of medicine. along with the many excesses and constrictions within the law, the independent payment advisory board represents the very worst of the worst of what will happen. as a physician, as a member of congress, as a father, as a husband, as a patient in his 60's i am offended by the independent payment advisory board. this board is not accountable to any constituency and it exists only to cut provider payments to fit a mathematically created target. the board throws the government into the middle of what should be a sacred relationship between the doctor and the patient. the doctor and the patient

should have the power to influence prices and guide care, not this board. beyond controlling medicare, the independent payment advisory board's rationing will serve as a benchmark for private insurance carriers' own payment changes. that's right. although mr. waxman, the moment the fact that private insurance would be part of medicare, this thing will actually dictate the behavior of private insurance's -- private insurances in this country. the board will have far-reaching implications beyond medicare for our nation's doctors. because of the limitations on what the control board can cut, the majority of spending reductions will come from cuts to part b, doctors' fees. doctors will become increasingly unable to provide the services that the board has decided are not valuable. is the answer to squeeze out doctors? sounds like rationing to me. so which sounds like the better option? medicare bankruptcy and an unelected board deciding the care of medicare beneficiaries or doctors and patients deciding

and defending the right of the care that they receive? the future of american health care should not be left up to this board, to to this panel. it's an aloof arbitrarier of health care who depend on health care. i'll just leave you with a quote from the american medical association. it puts our health policy and payment decisions in the hands of an independent body with no accountability, major changes in the medicare program should be decided by elected officials. from the american medical association. i yield back. the chair: the gentleman's time has expired. the gentleman from california. mr. waxman: mr. chairman, i am pleased at this point to yield to my colleague from california, one of the key people in the authorship of the affordable care act, george miller, for three minutes. the chair: the gentleman from california is recognized for three minutes. mr. miller: i thank the gentleman for yielding. mr. speaker, i came to congress in 1975 and since that time i've been involved in the debate over national health reform

proposals. throughout these debates lawmakers struggle with how to control costs without sacrificing quality care. unfortunately for decades congress chose to kick the can down the road while costs continued to climb and to soar. this trend ended with the affordable care act. for the first time congress put in place specific identifiable measures that will make our health care system more transparent and efficient. this includes the creation of the independent payment advisory board, this board will be a backstop to ensure that federal health programs operate efficiently and effectively for both seniors and the taxpayers. we need to give these innovations a chance to work because without these innovations there is little hope that -- to get health care costs under control. 535 members of congress cannot be nor should they be the doctors who think they know best of the practice of every medical field. 535 members of congress are not immune to special interests that have a financial stake in the decisions that are made. not necessarily the best

interests of the senior, the taxpayers or the delivery of medicine in this country. but perhaps in the best interest of their companies. that's why the affordable care created an independent board of health experts to make recommendations to improve the system. it does not usurp the role of congress, it simply acts as a failsafe in case government spending exceeds benchmarks. under the law doctors will attain full authority to recommend the treatment they think are best for patients. the law also prohibits the recommendations that would ration care, change premiums or reduce medicare benefits. in short this independent board is about strengthening medicare with evidence-based decision making. without innovative reforms like the board, medicare's future will be put in jeopardy, kicking this can down the road any further will only bolster those who seek to kill medicare. we must strengthen medicare, not end the medicare guarantee. the affordable health care act strengthens medicare, extends the life of the trust fund and has already lowered the cost for millions of seniors. however, without innovation, our current system will be

unsustainable for our nation's families, businesses and taxpayers. the republican plan to end medicare guarantee is no alternative. innovation is the alternative. and i urge my colleagues to support the independent payment advisory board and reject this legislation. the chair: the gentleman's time has expired. the gentleman from pennsylvania. mr. pitts: mr. chairman, i would much rather hear from some of our doctor friends who are speaking so eloquently. i have another doctor member of the health subcommittee from pennsylvania, distinguished gentleman, dr. tim murphy. i yield for two minutes. the chair: the gentleman from pennsylvania is recognized for two minutes. mr. murphy: i thank the gentleman. when i was a state senator of pennsylvania i took on h.m.o.'s and plans that made decisions by accountants and m.b.a.'s and not m.d.'s. it was important to do that because we found that doctors could not make decisions even though they were supposedly empowered to do that.

instead, there was boards that would make decisions for them. and now here we are with deja vu all over again. we're about to have 15 presidential appointments, even under the advice of both chambers of commerce -- excuse me, both chambers of congress, none of them are involved with medicine, making decisions with regards to who makes decisions for you. in terms of what gets paid and how much gets paid to doctors and hospitals. but as it goes through, what happens if there's a decision that says it's not going to be covered? can you call the board itself? no. can you -- can your doctor call the board? no. can your hospital call the board? no. can your member of congress call the board? no. in fact it will take an act of congress passed by the house and senate and signed by the president to override that. so who is this panel and what decisions can they make? it's people who are involved with finance, economics, hospital administration, reimbursements. some physicians, a health professionals, pharmacy benefit managers, employers, people involved with outcome research

and medical health services and economics. what's missing from that is any requirement that it might be people who have knowledge of such things as oncology, pediatrics, geriatric medicine, family medicine, surgery, and the list goes on and on. so in other words what's going to happen here is not only you don't like your doctor, you may not be able to keep it, but if your doctor doesn't like what is going to be covered, there's nothing that he or she can do about that. this is not the practice of medicine. this is the practice of government overtaking medicine. while americans were begging for us to fix a broken system what they got was half a trillion in new taxes, trillions -- half a trillion in medicare cuts, trillions in new costs and massive mandates. 1,978 new responsibilities of the secretary of health, 150 boards, panels and commissions yet to be appointed and we don't know what's going to happen. we need to return health care to where it really is going to be fixed. and with that i yield back. the chair: the gentleman's time has expired. the gentleman from california.

mr. waxman: mr. chairman, i yield myself one minute. the chair: the gentleman is recognized. mr. waxman: we're talking about the independent payment advisory board. advisory board. and the appointed membership of the board shall include physicians and other health professionals, experts in the area of pharmaceutical economics or prescription drug benefit programs, employers, third party payers, individual skills in the conduct and interpretation of biomedical health services. dot, dot, dot. these are people who will give us some recommendations but they can't give us a recommendation to take away services. they can't give us a recommendation to impose more costs on the medicare beneficiaries. and when they give us their recommendations, congress can act on it. and if we don't like it, we can change them. i think we have the republicans trying to scare people. they come in and say, medicare

costs too much. well, if it costs too much, that's why we need this backup. to be sure that we're holding down costs. they say it costs too much and therefore let's end it. that doesn't make any sense. i think the americans should not be fooled. mr. chairman, i'd like to now yield to my colleague from california, the chairman of the subcommittee of the ways and means committee, mr. stark, for three minutes. the chair: the gentleman from california is recognized for three minutes. mr. stark: thank you, mr. chairman. i ask unanimous consent to revise and extend my remarks and i -- the chair: without objection, so ordered. mr. stark: i want to thank chairman waxman for yielding me at this time. i rise in opposition to h.r. 5, brought to the floor by my republican colleagues. it does two things. repeals ipab as created the affordable care act, and it enacts a medical malpractice reform long sought by my

republican friends as a way to protect pharmaceutical companies, medical device companies, health care providers from any liability or full liability that may cause harm or death. the medical malpractice part of this bill is so bad the california medical association rejects the bill and says to vote no unless they had a decent medical malpractice reform part in it and when the doctors will reject medical malpractice reform issues, you know it's got to be bad. . this extreme proposal is really not needed. i happen to agree with the part of the bill that repeals ipab. we refuse to include it in the house version of health reform, and congress has always stepped in in its congressional manner to strengthen medicare's

finances when needed, and i see no need for us to relinquish that duty. we only have to look at the health reform law. it's extended solvency, it slows spending growth, it's lowered beneficiary costs, it's modernized the delivery system, created new fraud-fighting tools. we've done a good job. in fact, c.b.o. project that ipab won't even be triggered until the next 10 years, proving we've already done our job here in congress of strengthening medicare's finances. today's republican support to repeal ipab isn't a sincere interest in providing medicare for all. they still want to give us an unfunded or underfunded voucher, slash and burn funding and despite my opposition to

ipab, it's far less dangerous to medicare than the republican voucher plan put forth in the house republican budget this week. if ipab doesn't undermine medicare's guaranteed benefits and its ability to reduce medicare spending, it has guardrails to prevent it. it doesn't prevent costs to come from reducing medicare and increasing costs on beneficiaries. it prohibits rationing and has annual limits on the cuts. the republican voucher plan has none of these protections. the republicans are continuing the march begun by newt gingrich to have medicare wither on the vine, and i urge my colleagues to vote no on yet another political stunt which really thankfully is not vested to become law at this time. i yield back. the chair: the time of the gentleman has expired. the gentleman from pennsylvania. mr. pitts: thank you, mr. chairman. i just like to take 30 seconds to respond to the -- the chair: the gentleman is recognized for 30 seconds. mr. pitts: before i yield to

mr. bass, he mentioned that this so-called expert panel could have physicians, health care professionals. i refer him to section 3403-g of ppaca on page 432, specifically on majority for the panel. there's a specific prohibition that you can't have a majority of health care providers or physicians on ipab. as far as this being recommendations, you can't appeal, you can't sue this board only with 3/5 votes in both chambers can you overturn their recommendations. i yield one minute to the gentleman from new hampshire, mr. bass. the chair: the gentleman from new hampshire is recognized for two minutes. mr. bass: i thank my friend for yielding. mr. speaker, i rise in support of the bill consisting of two bills, tort reform and repeal of the independent payment advisory board. i wasn't here when the obama

health care law or affordable care act was passed. you would have thought that nobody supported this bill. of all the speakers we had i think three have admitted they supported it then. and now you think it never existed. well, any agencies that's scored by c.b.o. to save $3.1 billion is not going to do it by providing more services to seniors or innovation or preservation. it's going to do it by cutting payments to providers or cutting services to beneficiaries. it's as simple as that. and this is the beginning or perhaps the core of what represents a federal government takeover of health care services in this country. sure, there may be a process whereby recommendations could go to the congress, but instead of the relationship being between a patient and a doctor, it is going to be governed more by a federal bureaucracy that will make these decisions. i urge support of the pending bill, h.r. 5.

the chair: the time of the gentleman has expired. the gentleman from california. mr. waxman: mr. chairman, i yield myself a minute. the chair: the gentleman is recognized. mr. waxman: we heard them in 1965 when medicare was being proposed. socialized medicine, an unfair government intrusion into our lives. medicare is a popular, successful program. i support it but the republicans didn't support it then and they don't support it now. the affordable care act is an excellent bill. i proudly voted for it because as a result of that legislation, we're already seeing young people being able to get insurance up to 26 years of age on their parent's policies. we're already seeing seniors get help to pay for their prescription drugs. we are seeing insurance companies prohibited from the abuses where they put lifetime limits and are going to be stopped from denying people health insurance because of

pre-existing medical conditions. this is good and we are going to get more benefits for over 30 million more americans when the bill is fully in place. it's a good bill. the republicans would like to repeal it but let's not forget, they didn't want medicare in the first place. mr. chairman, now that i used my minute, i'd like to yield to the -- to a member of our committee from the state of illinois who has been very involved in helping seniors on all of these programs, whether it's social security or medicare or medicaid. she's very knowledgeable and highly respected. a little shorter than the podium, but i'm pleased to yield her three minutes. the chair: the gentlelady from illinois is recognized for three minutes. ms. schwartz: thank you very much for --

ms. schakowsky: thank you very much. i ask unanimous consent to revise and extend my remarks. the chair: without objection, so ordered. ms. schakowsky: h.r. 5 represents another in a long line of partisan political attacks on the affordable care act. since its passage two years ago, this historic law has been under attack. today's bill would repeal the independent payment advisory board. the affordable care act is replete with provisions to lower medicare costs from unprecedented tools to fight fraud to efficiency reform. the ipab is a backstop to those provisions. when the affordable care act does not do and what the ipab is prohibited from doing is increase costs to seniors and people with disabilities or cut benefits. and that may be why my republican colleagues don't like it. if you look at their proposal to take away the medicare guarantee and turn it into a voucher program, you can see why. instead of lowering costs for everyone, as the affordable care act does, the republican plan just shifts costs on the

backs of those who can least afford it -- seniors, disabled people and their families. these are the same people who are harmed by the tort reform provisions, h.r. 5. federal intrusion, coupled with the disregard for injured consumers. instead of working to improve health care quality, as the affordable care act does, h.r. 5 simply restricts the rights of patients harmed by dangerous drug companies, nursing homes, medical device manufacturers, doctors or hospitals. i'm especially opposed to arbitrary caps on noneconomic damages. economic damages provide compensation for lost wages. noneconomic damages provide compensation for injuries that are just as real and damaging. injuries like excruciating pain or disfigurement, loss of a spouse or grandparent, inability to bear children. these are discriminatory for seniors and children who don't have lost wages, who aren't worth much.

higher costs to disabled people and seniors and fewer legal rights for injured consumers, it's a bad deal on both counts. mr. speaker, i yield back to mr. waxman. the chair: the gentlelady yields back her time. the gentleman from pennsylvania. mr. pitts: mr. chairman, at this time i yield one minute to another distinguished member of the health subcommittee, mr. guthrie from kentucky. the chair: the gentleman from kentucky is recognized for one minute. mr. guthrie: i thank the gentleman for yielding. thank you, mr. speaker. i rise today in support of h.r. 5, legislation to repeal the ipab, and make critical reforms to medical liability system. the ipab was created in the health care law as a way to contain growing costs burks the reality is most savings will likely be found by placing decisions in the hands of unelected bureaucrats. and it addresses the critical issue of medical liability reform. our current tort system is driving doctors out of the practice of medicine.

those remained are forced to practice defensive medicine. the congressional budget office has estimated that medical liability reform will save hardworking taxpayers over $40 billion. h.r. 5 makes two commonsense reforms to protect doctors and patients. i urge my colleagues to support the bill and yield back the balance of my time. the chair: the gentleman yields back his time. the gentleman from california. mr. waxman: mr. speaker, may i inquire how much side has? the chair: the gentleman from california has 36 minutes remaining. and the gentleman from pennsylvania has 44 minutes remaining. mr. waxman: mr. chairman, at this time i yield five of our 36 minutes to the gentleman from iowa, mr. braley. the chair: the gentleman from iowa is recognized for five minutes. mr. braley: i thank the gentleman for yielding. mr. speaker, here we go again. my conservative friends are once more trying to take away rights of american citizens

that are as old as the declaration of independence and the bill of rights, and they're doing it by talking about taking away the rights of patients without ever mentioning the word patient safety. this issue has been with us for a long time, and in fact about 10 years ago, the highly regarded institutes of medicine did three studies on the issue of patient safety and the alarming cost it adds to our overall health care delivery system. the first of their studies was called to err is human, building a safer health system. and on this cover it says, first, do no harm. the study concluded that every year up to 98,000 people die in this country due to preventable medical errors. and it also taught in this -- talked in this study about the cost of those medical errors.

the cost of failing to stop these preventable medical errors is between $17 billion and $29 billion a year. now, if you multiply that over the 10 years of the affordable care act, that means if we eliminated those errors, we would save $170 billion to $290 billion a year. so do we focus on patient safety and preventing medical errors? no. we focus on taking away the rights of the most severely injured because that's what caps on damages do. they penalize those with the most egregious injuries and those who have no earning capacity. so who are those people? they're seniors, they're children and they are stay-at-home mothers. those are the ones most severely penalized when you take away that.

so i oppose this bill in the name of the tea party. not just the current tea party but the original tea party which was founded in opposition to taxation without representation. and if you go to thomas jefferson's declaration of independence, you will see that grievance against king george listed, and right below it in the declaration of independence is this grievance, that he has taken away the right of trial by jury and that right was so important, ladies and gentlemen, that it was embedded in the seventh amendment to the bill of rights. and it says very clearly that in suits at common law, which is what a medical negligence claim is, the jury gets to decide all questions of fact and no one else. well, one of the most important questions of fact in a jury trial is the issue of damages, and my friends are trying to take away that right from the jury, the very same people who elected us to congress, because

they apparently think that congress knows more than the people who sent us here and who go into jury boxes all over this country in your state and listen to the actual facts of the case before deciding what's fair, including the all-important issue of what are fair and reasonable damages. so they're talking a lot today about defensive medicine. i want to tell you about the myth of defensive medicine. every time a health care provider submits a fee for services, they represent that that medical procedure or that medical test was medically necessary, and if they don't make that representation, they don't get paid. well, guess what, folks? if something is performed and billed as medically necessary, that by definition is not defensive medicine, because defensive medicine is when you're doing something that's not medically necessary to protect yourself from litigation. so you can't have it both ways.

you can't take the money and claim you're practicing defensive medicine. we also heard about the myth of setting these caps 30 years ago and never adjusting them for inflation. they also want to talk about the california bill that was passed in the mid 1970's and imposed the very same cap in this bill, $250,000. what they don't tell you is if you adjust that cap based on the rate of medical inflation over that same period of time, the cap would now be worth almost $2 million, and then if you reduced that $ 50,000 cap to -- $250,000 cap to present value, those are only getting the equivalent of $64,000 no matter how serious their injury is, and that's why i oppose this legislation and that's why people who believe in the constitution and in the states' rights under the 10th amendment to decide what their citizens will receive as justice should

be outraged that this bill is on the floor today, and with that i yield back. the chair: the gentleman's time has expired. the gentleman from pennsylvania. mr. pitts: mr. chairman, at this time i yield to another valued member of the health subcommittee two minutes, the gentleman from new jersey, mr. lance. the chair: the gentleman from new jersey is recognized for two minutes. lants lance thank you, mr. speaker, -- mr. lance: thank you, mr. speaker, and thank you, mr. chairman, for yielding. i rise today in support of h.r. 5, as it combines the repeal of the independent payment advisory board with significant medical malpractice reforms that will help reduce health care costs and reserve parents -- patients' access to medical care. today marks the two-year anniversary of house passage of the president's health care law. during that debate two years ago i joined members from both sides of the aisle in calling on the president to address one of the drivers of the high costs of health care by reforming the current medical liability

system. unfortunately the president's health care bill passed the house on march 21, 2010, absent any real or meaningful medical liability reform. the new claw did include the independent payment advisory board or ipab, and this cost-controlled board made up of 15 unelected and might i add unconfirmed officials has the power to make major cost-cutting decisions about medicare with little oversight or accountability. the ipab has been criticized by both republicans and democrats and its repeal is supported by nearly 400 groups representing patients, doctors and employers. today on the two-year anniversary of the house passage of the health care law we have an opportunity to move to the future and enact real health care reform that will help bring down health care costs that are escalating at unsustainable rates while at the same time protecting needed care for our

senior citizens. as a member of the house energy and commerce committee, i'm pleased to have the opportunity to work on this important legislation and urge all of my colleagues to support h.r. 5. mr. speaker, i yield back the balance of my time. the chair: the gentleman's time has expired. the gentleman from california. mr. waxman: mr. chairman, i'll continue to reserve our time. the chair: the gentleman from california reserves his time. the gentleman from pennsylvania. mr. pitts: mr. chairman, at this time i yield to another distinguished member of the health subcommittee, dr. gingrey, for two minutes. the chair: the gentleman from georgia is recognized for two minutes. mr. gingrey: mr. chairman, i thank the gentleman for yielding and of course i stand in strong support of h.r. 5, the path act. having authored half of the legislation, that is the health act, the medical liability

reform act, but i'm also strongly in favor of repeal of ipab, the independent payment advisory board, created under obamacare. we know and our colleagues on the other side of the aisle, many of them know that this is the most egregious part of this 2,700-page piece of legislation which is now the law of the land. but what it is, mr. chairman, ipab is their way of saving medicare. i'll ask them time after time, what is your plan to save medicare? they have no answers. all they want to do is continue to criticize our side of the aisle when we have meaningful, thoughtful plans to save and protect and strengthen not just for these current recipients under the medicare program, those who are seniors, those who are disabled, but also our

children and our grandchildren. what do we get from this side of the aisle, from the democratic side? we get ipab. the language says no rationing yet the provisions call for cutting reimbursements to providers and eventually without question, just as it has in canada, in the u.k., mr. chairman, that leads to denial of care and if that's not rationing i don't know what it is. let me in the remaining part of my time speak a little bit in regard to h.r. 5, the health act, the medical liability reform act. the gentleman from iowa, the trial attorney, was just up here trying to imply that we would take away a person's right to a redress of their grievances if they had been injured by a medical provider or health care facility because of practice below the standard of care. mr. pitts: i yield the gentleman another minute. the chair: the gentleman is

recognized. mr. gingrey: i thank the gentleman. the gentleman from iowa knows in fact that that is absolutely not true. what we do in this health act is limit the awards for so-called pain and suffering at $250,000. and, mr. chairman, indeed a number of states after california enacted this law 35 years ago, texas, florida, my own state of georgia, have enacted caps higher than that. and no doubt other states will do so in the future. because this bill specifically says, and it's called the flex caps, that if a state wants to enact the limit on noneconomic of $1 million and have it applicable to multiple dividends, they can do that. they have the -- defendants, they can do that that. they have the right to do that -- they can do that. they have the right to do that. in regard to injuries to a

patient, there are no caps whatsoever. there are still suits that are awarded to injure the patients that are in the millions of dollars. so the gentleman from iowa was totally disingenuous in what he was trying to explain, very smooth talking, very convincing lawyer. that's what we expect. but we want to end frivolous lawsuits. that's what this bill does. i yield back the balance of my time. the chair: the gentleman's time has expired. the gentleman from california. mr. waxman: mr. chairman, i yield myself one minute. i say to the gentleman who is a physician -- i thank the gentleman who is a physician for his comments. he said he wants to save medicare. he says that republicans want to save medicare. they want to save medicare but their budget proposal would end medicare. let's just understand those who are on medicare know they can go to the doctor or the hospital or other health care provider and medicare will pay. under the republican proposal, they would be given a voucher

and told to go buy private insurance policy, as much as they can afford, by adding additional money. to save it they'll want to end it. and we hear the statement, so-called pain and suffering. the people who are living their lives with constant pain and suffering from a medical malpractice problem, it's not so-called to them. it's a real terrible situation that they have to live with. and i think that because one of our speakers happens to be a trial lawyer, i want to point out that the past speaker is a medical physician. as if that should make a difference. let's base our arguments on the points that are made. i at this point want to yield three minutes to the gentleman from vermont, an important member who we hope will come back to our committee in the very near future, mr. welch. mr. welch: i thank the gentleman. in vermont we faced the

challenge that we face in this nation. we want to have access to health care, we want it to be affordable. when we add legislation, the democrats were pushing access, the republican governor was concerned about cost. we sat down and realized we're both right. if democrats want to achieve the goal of access to health care for everybody, we have to control cost. our republican governor was right. we worked to do that. this congress has failed to do that. health care costs are rising beyond our ability to pay. whether it's the taxpayer, whether it's the business that's paying the premiums, whether it's an individual with self-pay, you cannot have health care costs rising at 6.5% a year as they have for the past 10 years, higher than the rate of inflation profits or the economic growth, it can't be sustained. ipab is a tool to help us control health care costs. we have to do that for our

taxpayers, for our employers and for our citizens. it's advisory. these 15 people who have experience in economics and in medicine will look at data, will look at information, what's there to fear in them doing that? and they'll make recommendations to congress. congress will retain the right to have the final say as to whether these recommendations will work or not or we want to substitute something else. that makes sense. the alternative is what has been put forward to essentially shift the burden of rising health care costs on to seniors -- onto seniors and citizens by turning medicare into a voucher. it would cap what the taxpayer would pay by exempting this congress from making reforms in how we deliver care that could

result in costs coming down and simply say to seniors on medicare, that if costs goes up 6.5% a year, another 6.5%, you know what, folks? you are on your own. figure out how to pay for it. congress is awol on this. so, to the extent that we claim we want access but we won't control costs and take steps that are required to make health care spending sustainable, we're shirking our responsibility. ipab is not the answer but it's a good tool. and to reject it and instead replace it with a voucher system where the full burden of runaway health care costs are simply imposed on seniors, is the wrong way to go in a continue -- and a continuation of congress ducking its responsibility for the reforms in the health care can system that our citizens need -- in our health care system that our citizens need and deserve.

i yield back. the chair: the gentleman yields back the balance of his time. the gentleman from pennsylvania. mr. pitts: mr. chairman, i'm pleased at this time to yield three minutes to one of our leaders, distinguished gentleman from texas, mr. hensarling. the chair: the gentleman from texas recognized for three minutes. -- is recognized for three minutes. mr. hensarling: mr. chairman, regrettably the president's policies have failed and continue to harm our economy. we were told if we would pass the stimulus plan unemployment would never exceed 8% and instead it's exceeded 8% for 37 straight months. we were told that the president would cut the deficit in half and instead we have the worst debt in our nation's history. we were told he would take steps to reduce the price of oil and instead gas prices have doubled at the pump. and one more of his policies that has failed is clearly his health care plan. we were told that it would create jobs but instead every day i hear from job creators in

the fifth district of texas who write me things like, quote, obamacare will put a tremendous burden on my company. i can't put a five-year plan in place, i therefore have to withhold cash for expansion. i also hear things like, quote, i could start two companies and hire multiple people but based on this administration and the lack of facts with obamacare, i will continue to sit and wait. we know now that the congressional budget office says that the health care plan will cost us almost $1 million -- a million jobs from this economy. we are also told that if we pass this, that health care would be more affordable and lower premiums. but instead the congressional budget office now tells us that the new benefit mandates will force premiums to rise in the individual market by $2,100 per family. any way you look at it, the president's health care law is harming job growth, it's harming

our economy, but perhaps even more ominously it's infamous -- its infamous independent payment advisory board, that will harm our seniors. the ipab is going to be comprised of 15 unelected, unaccountable bureaucrats hand picked by the president. their job is going to be to ration health care to our seniors and impose federal price controls. this will undoubtedly slash senior access to doctors and to other providers. they literally will be making decisions about the health of our loved ones, our parents and our grandparents. the center for medicare and medicare savings actuary has confirmed that, quote, large reductions in medicare payment rates to physicians would likely have serious implications for beneficiary access to care, utilization, intensity and

quality of services. mr. chairman, when it comes to my parents, both of whom are on medicare, no government acronym, no government bureaucrat, no government board can ever substitute for the good judgment of their chosen family doctor and that's why today i am proud to stand with my colleagues here to vote to repeal the ipab and once again we need to repeal the president's health care plan and do it today. i yield back the balance of my time. the chair: the gentleman's time has expired. the gentleman from california. . mr. waxman: i'm pleased to yield to the distinguished democratic whip, mr. hoyer. the chair: the gentleman is recognized for four minutes. mr. hoyer: i want to speak about this bill but i want to respond to the chame of the republican conference who fails to realize we've created 3.6 million new jobs over the last

four months and had 10 quarters of growth in america as opposed to losing 786,000 jobs the last month of president bush's term, we aed 257,000 last month in the private sector. so to say the president's program is not working is simply inaccurate. ladies and gentlemen, this is a wolf in sheep's clothing. they don't like the health care bill, that's what the chairman of the conference just said, he wants to vote to repeal that. we understand that. they want to pick it apart, piece by piece. let me talk about it. two years ago, we passed a comprehensive health care reform package that's already lowering costs, expanding access and contributing to deficit reduction. the affordable care act was a significant moment when congress once again took bold action to constrain the growth in health care spending and make insurance more accessible and affordable for all americans. in the wealthiest country on

the face of the earth, we ought to make sure people can get insurance and have affordable, accessible health care. insurance companies can no longer deny coverage to children with pre-existing conditions, i bet they think that's a benefit, and that provision will extend to every american by 2014. insurance companies can no longer drop americans from their policies when they get sick or impose arbitrary or unfair caps on coverage you buy insurance to make sure when you get sick, you have coverage. when you get very sick, you need more coverage, it says you can't cancel because you're really sick. i think americans like that since the affordable care act was signed into law, over 32 million seniors, 32 million seniors on medicare have accessed free preventive services. the medicare part b doughnut hole son the path to complose completely by 2020 and seniors who fall under this coverage gap are right now getting a 50%

discount on their brand drugs. they like that. 360,000 small businesses have already take b advantage of tax credits that are helping them provide more affordable coverage to over two million workers. lifetime limits on over 105 million americans with private insurance have been eliminated. over 2,800 employers have already received financial assistance that help thems provide affordable insurance to 13 million retirees who are not yet eligible for medicare. c.b.o. continues to project that the affordable care act will continue to reduce deficits by tens of billions of dollars by the end of this decade. despite all these benefits, today republicans will take yet another vote to repeal part of the affordable care act. what they want to do is repeal the act. that's what the chairman said of the conference. i take him at his word. i appreciate his honesty.

today their focus son the independent advisory board, ipab. ipab is a back stop mechanism to ensure that the affordable care act's savings an cost containment provisions will be achieved. but c.b.o. has already said they don't expect it to be triggered at all over the next decade. that's because the affordable care act's cost containment provisions are already having a significant impact on slowing the growth of health care and medicare spending. this proves that the medicare spending can be constrained without turning medicare into a voucher program as the chairman has said. that forces seniors to spend more and ends the medicare guarantee. americans don't want that. the republican plan does exactly that and tries to mask the end of medicare as we know it by talking about choices and competition. >> i wreeled the gentleman an additional minute. the chair: the gentleman is recognized for one additional

minute. mr. hoyer: both competition and choice already exist in the medicare program. 99.7% of of beneficiaries have access to at least one medicare advantage plan and the majority of counties they have an average of 26 private plans to choose from. in spite of all these choices, about 75% of all seniors still choose to remain in traditional medicare. the republican budget released just yesterday paints a clear picture of their priorities, showing once again that they stand for ending the medicare guarantee, shifting ever-increasing costs onto our seniors and repealing all, all of the affordable care act's patient protections. i stand behind the cost containment provisions, the delivery system reforms and the new benefits and protections enacted urn health reform and i stand with my fellow democrats and america's seniors in support of repr serving the medicare guarantee and ensuring

medicare remains available and affordable for generations to come and i appreciate the ranking member's leadership on this issue and all of those who were critically response nble ensuring that americans have access to affordable, quality health care and i yield back the plans of my time the chair: the time of the gentleman has expired. the gentleman from pennsylvania. >> thank you, mr. chairman. they said it would cost $1.5 trillion, now it's up to $1.7 trillion. stay tuned. i yield two minutes to the author of the ipab repeal, the gentleman from tennessee, dr. roe for two minutes. the chair: the gentleman is recognized for two minutes. mr. roe: if this plan is so popular with the american people, that's why 60% want it overturned, that's the latest i've seen. let me go over what the ipab is

and why i'm so opposed to it. i've looked at this and seen 2002 examples already of why i know and what i know is going to happen here. we have the model in the s.g.r., the sustainable growth rate where we pay medicare physicians today, has been stated multiple times, we have a board with 15 appointed people to it, over half of whom cannot be health care providers or cannot be health care related folks making digs based on a formula for medicare spending. we're going to set limits. if you exceed the limits, cuts will come to providers. we've done that with s.g.r. and guess what congress has had the ability to do all this time? over ride those cuts. we understand if we cut our providers, we're going to decrease access for those patients system of what's happened with s.g.r.? just two weeks ago, we passed an s.g.r. temporary fix to the end of this year to avoid a 27%

cut in physician payments. guess what would happen with ipab? a 27% cut, mr. chairman, medicare providers and in five years, also the hospitals are included. i can tell you our rural hospitals where i live will not survive those cuts. and those will -- those cuts will occur with minimal, minimal overload from this congress and no judicial review. let me read this right here. ipab is the single biggest yielding of power to an independent entity since the creation of the federal reserve. this is not me, this is peter orszag, the former budget director for president obama. my concern as a practicing physician is if we cut physician payments so far that our patients will not have access to us, and right now, mr. chairman, in the primary care group i'm in, that access has already been limited and we see it around the country. i yield back the balance of my time. the chair: the time of the

gentleman has expired. the gentleman from california. mr. waxman: i yield -- he wasn't quite -- mr. pitts: i yield another minute to the gentleman. mr. roe: as an obstetrician, i started practice in 1977, delivered almost 4,000 babies, when i left -- i paid $4,000 for malpractice insurance. when i got back home from the army, all malpractice carriers had left tennessee. almost all practitioners in tennessee get their insurance from a mutual company. over half the people yum dollars every doctor has paid in as gone to attorneys, not to the injured party. less than 40 cents of every dollar has gone to the people who have actually been injured. we have a terrible system of

paying people who have been injured compensating them. and this will allow taos do that and allow us to get some certainty so that those costs don't keep rising beyond anybody's ability to pay. and what's happened in a lot of places, mr. chairman, is access to o.b. doctors and high-risk doctors has been limited because of the liability. i strongly support h.r. 5 and encourage my colleagues to do the samism yield back the balance of my imtime -- of my time. the chair: the gentleman from california. mr. waxman: nobody will deny there's a problem with medical malpractice. the issue is where the state of tennessee can adopt a law to control its own problem the way california has done and other states have acted. let the states operate in this area which has been a traditionally reserved for them. washington does not have all the answers. imposing one system on the whole country is not the way to go. i'd like to at this point yield to the gentleman from the state

of washington, mr. mcdermott, for three minutes. the chair: the gentleman from washington is recognized for three minutes. mr. mcdermott: i ask unanimous consent to insert my remarks in the record. the chair: without objection, so ordered. mr. mcdermott: mr. speaker, you might ask why we're having this debate. well, the republicans have never wanted to solve the americans' problems with health care access and cost. and the congress passed with the president's help a bill that gave access to many millions of people and put in place a meck -- some mechanisms to control costs. now they tried to repeal it, the republicans, again and again, mr. speaker. and they know that next wednesday, it's going to be in the supreme court. so today is press release time. and they have a formula for

press releases in this house. members are going home to their districts, so they select a straw man and they put him up here, the straw man in this case is the ipab. and then they scare seniors. they say, this ipab is going to take away your health care and all the seniors are supposed to crawl under the chair or under the bed because the republicans are out scaring people again. they do it by telling half-truths. this commission will make recommendations that the congress can adopt, change, or if they don't want to do it, they can let them go into place. now they have three choices and the congress can do either to change them or adopt them and they -- we are not giving away our power that is a half-truth

to say that we are. secondly, as you heard from the minority leader, or the whip, it's 10 years before this happens. so folks, if you're sitting at home watching this, mr. speaker, they're probably all scared, they've quit eating their dinner because they're worried about what's going to happen. we're talking about something that's going to happen in 10 years. this is simply a scare tactic and it is directly related to the attempt to derail the president's re-election. if they can take down this health care bill, they will have him. they will have shown he hasn't done anything. but the fact is, he got it through here and it's going to be implemented in 2013. now, you can spend all the time you want passing bills in here that are absolutely kabuki theater because this bill is going over to the senate, you all know it has to pass both

houses, the senate and the house, the senate put this in. does anybody think that the united states senate is going to take away seniors' rights to health care? does anyone think that? i mean, you're accusing the united states senate of putting this in the bill, setting it up to take away health care benefits from seniors. that's nonsense. if you think the senate is going to walk away from this provision, well, more kabuki theater, we'll be back on another day. thank you. we need to hold down the cost of health care for medicare itself. mr. waxman: costs are going up for all health care coverage. but medicare if it goes up too much, tst a real problem. so we try in the affordable

care act put in place to hold down costs by reorganizing the delivery of care, we have some other strategies and hope it will work. but for a back stop, if it doesn't work, there's this independent payment advisory board and they will give us some ideas of how to hold down health care costs. now, it seem to me the biggest objection is once you give the recommendation, we can accept them or we can change them or we can let them go into effect. i think the biggest problem is that if nothing happens, those health care costs go up and that's what the -- that's what the right of congress is, to let nothing happen. this is not how to hold down costs, this is to let the costs go up. i thank the gentleman for yielding. the chair: the time of the gentleman has expired. mr. mcdermott: i yield back the balance of my time. the chair: the gentleman from pennsylvania. mr. pitts: i yield three minutes

to dr. harris from the state of maryland. the chair: the gentleman from maryland is recognized for three minutes. mr. harris: thank you very much, mr. chairman. i think the gentleman from california just said what this is all about. the ipab is about cutting expenditures for our seniors on medicare when they need their health care. the ipab is no strawman. it's a health care policy bureaucrat's dream and a medicare patient's nightmare. it's 15 bureaucrats and the gentleman from california called it right, insurance company representatives, pharmacy company representatives, benefit managers, employers, all those people who really have the care of an individual patient in mind. in fact, that rationing board limits the number of health care professionals who can serve to a minority, a minority of people and then goes further and says,

oh, by the way, they have to actually stop practicing health care for the six years they sit on the board. how close are they going to be to knowing what's going on in the care of a patient? now the gentleman from iowa talked about the myth of defensive medicine. i want to ask anyone, mr. chairman, who cares, go on a labor and delivery suit and look at what's happened to obstetric care to our women in america over the past 40 years because we don't have effective tort reform. i'm -- i spent 30 years on a labor and delivery suit. in 1970 the c-section rate in this country was 5%. one in 20 women going to a hospital to have a baby would have a cesarean section. last year it was 33%. i'll tell you, not much has changed about child birth in

that time. but now one in three women, a woman going into the hospital to have a baby, one in three chance they're going to have a cesarean section. not only that, 40 years ago, those of you who want to ask people you know who delivered 40 years ago, most obstetrics delivered by a one or two person group where a woman got to another who was going to deliver her baby. go ask the folks in your district now what happens. you go to a group that have 10 or 12 people because they can't afford the malpractice insurance. they have to go in a big group so someone else can pay it. it's impersonal service. go and try to find a doctor who's in their 50s a -- 50's and 60's, they've given it up long ago because they can't afford the premiums. the most experienced obstetricians are no longer delivering care to american women. the c-section rate is one in three. and a woman can't even expect to

see her obstetrician every time she goes for those prenatal visits because there are eight or 10 in the group and they all have to get a chants to see -- to get chance to see that patient. that's what the lack of tort has done to the delivery of care to the women in this country. we need to pass this bill and pass it now. i yield back. the chair: the gentleman's time has expired. the gentleman from california. mr. waxman: mr. chairman, may i inquire how much time each side has remaining in the general debate? the chair: the gentleman from california has 17 1/2 minutes remaining. the gentleman from pennsylvania has 29 3/4 minutes remaining. mr. waxman: i'll reserve the balance of my time. the chair: the gentleman from california reserves his time. the gentleman from pennsylvania. mr. pitts: mr. chairman, at this time i yield to another doctor, the gentleman from indiana, dr. buechon, for two minutes. the chair: the gentleman from indiana is recognized for two minutes.

mr. bucshon: thank you, madam speaker. i urge president obama and our colleagues in the u.s. senate to join us and house republicans in saving access to quality care for america's seniors. i've been a practicing physician for over 15 years and i don't think i've seen anything potentially more detrimental to seniors' health care than the independent payment advisory board created under the affordable care act. as has already been said, a group of 15 unelected washington bureaucrats appointed by the president, making decisions on the funding of medicare with little oversight from your elected officials. this is not a partisan issue. whether it's this president, the next president or a president 0 years from now, no one should have -- 20 years from now, no one should have the power to create a board with this much control over health care. doctors provide critical care to our nation's seniors but they also run a business.

they have to receive proper reimbursement to keep their doors open or they will lose their ability to provide care for america's seniors. the affordable care act has already cut over $500 billion from the medicare program and then the president doubled down by proposing over $300 billion more in his budget. medicare cannot sustain further cuts if we're to keep access for america's seniors. without any chance of judicial or congressional oversight, ipab will become one of the most powerful agencies within our government. i ask the american people, what part of the government operates in this way? when the people of washington, d.c., make decisions you don't agree with, you can vote them out of office. but when ipab makes a decision, the american people most likely will have no recourse. if the president and the u.s. senate really are concerned about saving medicare, which

they claim to be, i urge them to get serious and work with us because according to c.b.o. medicare may be insolvent as soon as 2016. we need to reform medicare in order to strengthen and preserve it for its future generations and true reform is not continuing to cut funding of the program. again, i urge the president and the senate to join us in eliminating ipab. with that, mr. speaker, i yield back. the chair: the gentleman's time has expired. the gentleman from california. mr. waxman: continue to reserve my time. the chair: the gentleman from california reserves. the gentleman from pennsylvania. mr. pitts: mr. chairman, at this time i yield two minutes to another doctor, the gentleman from michigan, dr. ben check. the chair: the gentleman from michigan -- benishek. the chair: the gentleman from michigan is recognized for two minutes. mr. benishek: i thank the chairman for yielding. mr. chairman, and my -- as my good friend the chairman knows, before i came to this house i served as a general surgeon for

three decades. so two years ago this week, while president obama was pitching his 2,000-page health care overhaul, i was back home in michigan taking care of patients and wondering how this law was going to change the relationship between a physician and his patients. now the president's broken promises have shown us. instead of providing real solutions to strengthen the doctor-patient relationship or improving the way we deliver health care to patients, the president gave us the independent payment advisory board. ipab is a 15-member commission of unelected bureaucrats charged with cutting medicare spending, specifically reimbursement for physicians. it's a very washington-type solution. take something as personal as the doctor seeing his patient in an office and create a panel of washington bureaucrats to determine how that's going to be

paid for. as a physician i can tell that you when you set up an unelected board, give them unprecedented power and little government oversight, results will be clear. this will lead to arbitrary cuts to the medicare program, less access to care and rationing. today we are willing to stop that from happening. mr. chairman, we've already heard the other side of the aisle accusing the majority of pushinging grand ma off a cliff. but instead of scare tactics and hyperbole, i ask members of both sides of the aisle to support this effort to repeal ipab, support this legislation that eliminates what seniors are really concerned about, a group of unelected bureaucrats making health care decisions for them. as a physician i'm proud to support the repeal of this ill-conceived rationing board on behalf of all my patients and constituents in northern michigan. i yield back the balance of my

time. the chair: the gentleman's time has expired. mr. waxman: mr. chairman, i continue to reserve. the chair: the gentleman from california continues to reserve. the gentleman from pennsylvania is recognized. mr. pitts: mr. chairman, at this time i yield two minutes to another health care professional, a nurse, the gentlelady from north carolina. the chair: the gentlelady from north carolina is recognized for two minutes. mrs. ellmers: thank you, mr. speaker. and i thank the chairman for this opportunity to speak. with my colleagues, as a nurse, and a wife of a general surgeon. mr. speaker, ipab was created under obamacare to slash medicare spending by restricting health care services from seniors in need. repealing ipab will restore the doctor-patient relationship. mr. speaker, when someone goes to the doctor, they reveal the most personal experiences of their lives and engage in a relationship with the dedicated

health care professionals who put his or her career on the line for the purpose of making that individual whole again. left alone, president obama's government-knows-best mentality will force our seniors to cede this relationship to a board of unelected and unaccountable bureaucrats who will have the power over their health and the lives of millions of other americans. each patient is unique and their care rests on the doctor's ability to provide the best treatments available, regardless of the cost of their liability. one of the greatest challenges facing our nation's health care system, including medicare, is the rapidly rising costs. this legislation recognizes that. this legislation repairs and repeals the ipab with commonsense medical liability

reforms that will save billions of dollars. i have sat and listened to the debate today and i have listened intently over the two years since obamacare went into effect and i still have one question to my democrat colleagues across the aisle. what is your solution for medicare? we know it is not sustainable as it is now. what is your solution? mr. speaker, federal bureaucrats should not dictate to doctors how to provide care, force them to prescribe medications regardless of their known complications. i'd like to ask for 30 more seconds. mr. pitts: i yield another 30 seconds. the chair: the gentlelady is recognized. mrs. ellmers: thank you. and make them liable with no limits or protections. we have got to move forward on malpractice reform.

we should not place, you know, our colleagues ask the question, how can malpractice be put in place at the federal level? and yet they have put federal health care as an issue. and put control as an issue. we must provide patients and medical professionals with the security and the safety net. and i yield back. thank you. the chair: the gentlelady's time has expired. the gentleman from california. mr. waxman: mr. chairman, our idea for medicare for the future is to make it better, not to eliminate it. and in the affordable care act, we provided health for seniors to pay for their prescription drugs, especially the doughnut hole. we provide money so that they will be sure to have preventive services without having to pay for it. so that we know we can prevent diseases that they'd otherwise have to pay to treat. we have extended the life of the

medicare trust fund. we're always looking for ways to hold down costs in a reasonable, rational way. one of the reasons we had very high costs in medicare is that when a doctor and a patient get together, the doctor decides how many services, especially when that doctor gets paid more money for more services. and therefore we've got to look for alternatives to that. now, i have a feeling that a lot of doctors like the idea of deciding how many services are going to be paid for. but we just can't afford that. so we have ways to hold down health care costs by trying to bring people together in affordable care organizations, ways for doctors to manage the care from physician to physician in a more efficient way. and we have a backup of these other things -- if these other things don't work, to have an advisory committee to give us

ideas. but their ideas cannot lead to rationing health care or making people have to pay more money for their insurance or to restrict benefits or modify eligibility. that's what we propose to do. the republicans propose to take away the assured gearpt of services under medicare and require people to go find a private insurance plan if they can afford it over and above the voucher which would never keep pace with the increase in health care costs. i'm at this time going to yield two minutes to my california colleague, mr. thompson, to speak on our side of the issue. the chair: the gentleman from california is recognized for two minutes. mr. thompson: i rise today in opposition to this legislation. whether or not you're a fan of

the ipab, i strongly urge you to oppose the bill. this bill is not about ipab, it's nothing more than a political maneuver to attack the affordable care act on the two-year anniversary of its enactment. i challenge anyone to talk to one of the over 7,000 young adults in my district who now have health care insurance coverage and ask them if the affordable care act should be repealed. or maybe the 6,000 seniors in my district who have saved over $3 million in the cost of scription drugs. or the 30,000 children and 120,000 adults who now have health care insurance that actually covers preventive services without burdensome co-payments. or the thousands of children with pre-existing health conditions who will no longer be denied coverage by health insurers or told they hit their lifetime cap for services

because of a disease with which they were born. ask them if they'd like to repeal the affordable care act. -- the affordable health care act. no one ever suggested this bill was the perfect solution to health care but we should be working together to fix it, not trying to repeal it for cheap political points. and to add the malpractice, medical malpractice provision they added in this bill that is so wrong-headed that the doctors in california have come out in opposition to this bill. and any doctor will tell you, there's work that needs to be done in regard to medical malpractice, but the way this was done has even brought the doctors to the table in opposition. so on behalf of the millions of americans who are already benefiting from the affordable care act, i ask you to join with me and with the california doctors in opposition to this legislation that does no one any good at all. i yield back the balance of my

time. the chair: the time of the gentleman has expired, the gentleman from pennsylvania. mr. pitts: i find it interesting the gentleman who just spoke signed a letter to speaker pelosi in 2009 that said the ipab provisions, quote, severely limit congressional oversight of the medicare program and eliminate the transparaphernalia soif congressional hearings and debate. moreover, the creation of a medicare board would eliminate state input into the medicare program. >> would the gentleman yield? mr. pitts: ipab or an equivalent commission, they said, could not only threaten the beneficiaries but the ability of americans to access the care they need. i yield two minutes to the gentleman from new mexico, mr. pearce. the chair: the gentleman is recognized. mr. pearce: i appreciate the

tubs opportunity to speak on this legislation -- the opportunity to speak on this legislation. one of my mom's most trusted sources of information is her physician. she's in her 80's. we just got a history lesson a civics lesson from our friends across the aisle, expressing how the democratic house passed, the democrat senate passed and the democrat president signed into law a bill ways to control the costs. they took $500 billion from medicare in order to pay for the bill that they passed. they have given a political reality in that the senate is not going to take the bill up, therefore we should not be discussing it. i think for peace of mind for people like my mom, who are going to have ipab this independent board inserted between them and their doctor, mom won't even get to talk to her doctor if this board

decides she can't. the scheduler will say, you have to come back next month or next year. we're told we shouldn't bring that up because it might scare seniors. seniors have a right to be scared. they have a right to wonder. if some board that does not even answer to congress, it can change laws without coming to us, it can write its own rules, and we're told that we should not be discussing this issue because it might frighten seniors, it just might, and they very well should be. president obama's health care legislation did not bring one new doctor into service but it brought millions of new patients in. the real truth is we have increasing demand for doctor services because of these new patients and no new supply. you're going to have to limit somewhere. they wanted to hide this limitation under the ipab. we're simply saying, let's

restore the relationship between 86-year-old moms and the doctors, let's get rid of the ipab. this bill would do it. i yield back. the chair: the time of the gentleman has expired. the gentleman from california. mr. waxman: if you listen to the comments just made on the house floor, it would be better to leave over 30 million people without health insurance. because they'll want to see doctors. when they get sick. the legislation, the affordable care act, provides more training for doctors and a higher reimbursement for primary care doctors and it provides for the opportunity to get a medical education with a payback in underserved areas. we're going to get more doctors. but we shouldn't say that those who have health insurance should turn their back, as republicans, i feel, are doing, to all those who have no insurance whatsoever.

i want to yield at this point five minutes to the distinguished gentleman from the state of virginia, mr. scot , so he can further speak on this legislation. the chair: the gentleman is recognized for five minutes. mr. scott: thank you, mr. speaker. i rise today in opposition to h.r. 5. there are several troublesome po visions with the bill, for examplering it sets arbitrary and discriminatory cap on noneconomic damages, reduces the amount of time an injured patient has to file a lawsuit an repeals ipab, the board create by the aed for -- affordable care act to control medicare costs while preserving access to care. although there are many troublesome provisions with the bill, i'd like to speak at length about one provision, the so-called fair share provision. the fair share provision would repeal the general rule of joint and several liability. joint and several liability is a common law principle that

enables an injured patient to seek compensation from any or all of the parties responsible for the patient's injuries. joint and several liability provides that each of the guilty defendants are jointly responsible and individually responsible for the total damages and if they want, they can agree in advance on how to apportion fault among themselves. thus they can purchase and share the cost of insurance. and charge fees for services based on that agreement. the general rule of joint and several liability is not burden the injured patient with the requirement of assigning proportional fault. this act creates a bizarre and impossible standard for the patient by eliminating joint and several liability. it requires that the plaintiff who is the patient, demonstrate that each negligent party's proportional responsible. this is often impossible because frequently all the

patient knows is he wobaling up as the victim of malpractice. why should he then be required to find out what each and every person did and how does he do that when everybody is denying any liability? unfortunately this bill essentially requires the plaintiff to conduct a separate case against each defendant. each case requiring a finding of duty of care, breech of that duty, proximate cause, finding of daniels, and then a determination of what part of the damages are attributable to what malpractice. each of those cases requires an extensive -- expensive expert witness, depositions, an the full expense of complicated litigation. it also complicates any settlement that might take place but a patient -- because a patient can't settle with one defendant without knowing what the other defendants may have to pay. it eliminates join and -- joint and several liability for all kinds of damages, including economic daniels.

in doing so, h.r. 5 is more extreme than most state's laws. economic laws compensates injured parties for their out of pocket expenses such as hospital bills, doctor bills and lost wages an even though the propoachts h.r. 5 claim to use california's medical injury compensation reform act as a model, not even california eliminates joint and several liability for economic damages. mr. speaker, over centuries, each state has balanced judicial procedures between defendants and plaintiffs. each provides a longer or shorter statute of limitations. some have large, some small, and some no caps at all on damages. some deny recovery in contributory negligence, others allow recovery on negligence, most have joint and several liability, some do not. but it has been balanced in

each state. we should not override sempleries of state-level balancing of the interests by preempting some parts of tort law with this by we usually hear that tort reform is necessary to address three problems, defensive medicine, high malpractice proceed yums and frivolous lawsuits this bill will not do anything to deal with defensive medicine because the lawsuits are not eliminated. they'll still be defensive medicine. because it increases expenses for defendants, it may increase total malpractice premiums. finally, the bill does not target frivolous lawsuits. the institute ofed me cain -- medicine stilts that up to 100,000 patients die every year due to medical mistakes and yet there are only about 15,000 medical malpractice payments each year, so there's a question of whether or not frivolous lawsuits is even a problem. to the extent that it is a

problem, this bill will not target frive rouse lawsuits but increase the cost of litigation and may reduce all lawsuits but will not target frive rouse lawsuits. mr. chairman, i would hope we would not pass a federal law to apolish state and -- joint and several liability at the state level. i would urge my colleagues to oppose this legislation. the chair: the time of the gentleman has expired. the gentleman from pennsylvania. mr. pitts: i yield two minutes to the gentleman from illinois, mr. holt. the chair: the gentleman is recognized for two minutes. mr. holt: thank you, mr. speaker. i rise today in support of this bill. the unelected and unaccountable bureaucrats of the independent payment advisory board pose a threat to the ability of seniors in my district and around this country to get the health care they need. mr. pult green: across my district, i hear from doctors who are deeply concerned about their ability to accept more medicare recipients because reimbursement rates are already

too low. mr. hultgren: but if the ipab bureaucrats are allowed to ration care, rates will be even lower. fewer doctors will be able to afford to treat medicare patients. it's cruel to tell our seniors they have medicare but refuse to tell them there will be no doctors to treat them. ipab will be the end of -- of medicare as we know it, the age of seniors being able to get treatment from their preferred doctors. we need to act now to protect seniors and to protect medicare. i hope my colleagues on both sides of the aisle will join me in supporting this bill. the chair: the gentleman yields back. the gentleman from california reserves. the gentleman from pennsylvania. mr. pitts: may i ask the gentleman how many speakers he has left. mr. waxman: we have one. mr. pitts: i yield to myself such time as i may consume. the chair: the gentleman veck

niced. mr. pitts: h.r. 5, the preserving access to health care act not only fixes our broken medical liability system but repeals the independent payment advisory board, one of the most ominous provisions in the president's sweeping overhaul of health care. medical liability reform will preserve access to health care in states like pennsylvania by allowing doctors in high-risk specialties such as obstetrics and neurosurgery to practice without the fear of frive rouse lawsuits and according to the congressional budget office, reduce the federal deficit by 48.6 -- by $48 ppt 6 billion over the next 10 years. according to the president's health care law, the purpose of ipab is to reduce the per capital growth rate. the board is made up, as we've heard of 15 unelected, unaccountable bureaucrats who will be paid $165,300 a year to serve six-year terms on the serve six-year terms on the board.