if medicare growth goes over an arbitrary target, the board is required to submit a proposal to congress to reduce medicare's growth rate. these recommendations will automatically go into effect unless congress passes legislation that would achieve the same amount of savings. in order to do so, congress must meet an almost impossible deadline and clear an almost insurmountable legislative hurdle. the board has the bower -- power to make binding decisions about medicare policy and with no requirement for public comment prior to issuing their recommendations, and individuals and providers will have no resource against the board because it decisions cannot be appealed or reviewed. in other words, the board will make major health care legislation essentially outside the usual legislative process. the board is also limited to how it can achieve the required savings, therefore, ipab's recommendations will be restricted to cutting provider reimbursements. in many cases, medicare already

reimburses below the cost of providing services and we're already seeing doctors refusing to take new medicare patients or medicare patients at all because they cannot afford to absorb the losses. any additional provider cuts will lead to fewer medicare providers and that meeps that beneficiary access will suffer. seniors will be forced to wait in longer and longer lines to see an ever-shrinking pool of providers or have to travel longer and longer distances to see a providing willing to see them. clearly, medicare growth is an out-of-control trajectory that endangers the solvency and continued existence of the program. ipab, however, is not the solution. i urge my colleagues to support h.r. 5. with that i'll yield back. the chair: does the gentleman yield back? mr. pitts: i reserve my time. the chair: the gentleman reserves the balance of his time. the gentleman from california. mr. waxman: mr. chairman, i am pleased at this time to yield

two minutes to the gentleman from new jersey, mr. rush holt. the chair: the gentleman from new jersey, mr. holt, is recognized for two minutes. mr. holt: mr. speaker, i thank my friend from california, and i rise in opposition to h.r. 5 which would repeal the independent payment advisory board which i think is one of the good features of the health reform law. you know, i have real concerns about h.r. 5. we're talking about undoing work instead of doing the work that this congress should do. repealing ipab in the pretext of protecting medicare just one day after the republican budget was released that would end medicare and shift the cost of health care to our seniors while giving tax breaks to millionaires, there's just no logic to this. the bill would also make

significant changes to the federal health care liability system, making it difficult for legitimately injured patients to hold health care providers accountable, including even limiting the ability of victims of sexual abuse from getting justice from the institutions and providers who harmed them. the health reform law, which the republicans want to repeal, included malpractice reform, like grant programs for states. and while i support improvements to the medical malpractice process, it's important to note that malpractice is not the primary, not really the significant reason for the escalating health care costs. states that have passed stringent limits on medical malpractice claims, like the ones in h.r. 5, have in fact some of the most expensive health care in the country. this bill is irresponsible, it's unnecessary. where's the transportation

bill? where are the jobs bills? why are we on the floor talking about undoing good work instead of doing the work that this congress should be doing? this bill is irresponsible and unnecessary. i urge my colleagues to vote no on this political theater, and i yield back. mr. waxman: mr. chairman, i'd like to yield an additional minute to the gentleman and ask him if he'll yield to me. mr. holt: i yield to my friend from california. mr. waxman: the problem that we keep facing is rapidly rising health care costs. it's not just for medicare. it's for private insurance. it's for anybody who has health coverage, the costs of health care are going up rapidly. and the approach of medicare has always been to look for ways to hold down the costs. there was a time that ophthalmologists would charge a

fee for removing the cataract, and then ask for another fee for inserting the lens. well, that made sense when that surgery was brand new, but they didn't want to give up the two fees that they were receiving because it would be a reduction in their reimbursement. medicare said, no, that really doesn't make sense. medicare does a lot of things to hold down costs, and then private insurance picks them up because so much -- so often it makes sense. another 30 seconds. mr. holt: and i yield to him. mr. waxman: the way to hold down costs is to try to reform the way health care is delivered, and medicare tries to do that. if we don't do it that way, the republicans would say that private insurance will be able to control it because that's all people are going to be able to get. no more medicare. they'll have to private

insurance and let the insurance company tell the doctor and the patient what they'll be able to do. with them trying to hold down costs without regard to the medicare patient. i thank the gentleman for yielding to me. the chair: the gentleman's time has expired. the gentleman from pennsylvania. mr. pitts: mr. chairman, we are prepared to close. have you -- mr. waxman: we will yield back the balance of our time. the chair: the gentleman from california yields back the balance of his time. the gentleman from pennsylvania. mr. pitts: thank you, mr. chairman. before i yield to the gentleman from georgia, dr. gingrey, for our close, i just want to remind him of a statement by the chairman, representative stark of the ways and means subcommittee on health during the debate of ppaca. he called the establishment of the board, quote, a dangerous provision that sets medicare up for unsustainable cuts. we should be reminded of that. at this time i yield to one of the authors of the legislation,

the distinguished member from the health subcommittee and a doctor, dr. gingrey from georgia. the chair: the gentleman from georgia is recognized. mr. gingrey: madam chairman, as a physician member and co-author of the bill, i am truly honored that chairman pitts is allowing me to close the debate on h.r. 5, the path act. appropriately named for meaningful medical liability reform and the elimination of ipab together will put medicare, specific, and health care in general, back on the right path, a path to fiscal solvency of 1/6 of our economy. a path to compassionate, cost-effective, efficient and timely health care for all who call this great country home. a path to fairness in our court

systems so that those injured by malpractice get their day before a jury of their peers and they are justly compensated, not crowded out by frivolous claims and out-of-control legal fees. a path to a bipartisan and a bicam rell -- bicameral solution to one of the most pressing needs our nation will ever face. that is to save medicare for our current seniors and strengthen it for all future generations. let's get started right now. our country cannot wait any longer. vote yes on h.r. 5, the right path act, and i yield back the balance of my time. the chair: the gentleman yields back. the gentleman from pennsylvania.

mr. pitts: i yield back the balance of my time. the chair: the gentleman yields back the balance of his time. the chair: the gentleman from michigan, mr. camp, is recognized. mr. camp: thank you, madam speaker. i yield myself such time as i may consume. the chair: the gentleman is recognized. mr. camp: madam speaker, today

i come to the floor to speak in support of h.r. 5, the protecting access to health care act, which among other things will repeal yet another poorly designed provision from the democrats' health care law. specifically this legislation would repeal the independent payment advisory board, ipab as it's commonly known is a dangerous new government agency with unelected bureaucrats who can meet in secrecy to say what will be paid. it restricts access to health care for medicare beneficiaries. nearly two years since its passage, the democrats' health care law remains deeply unpopular. with an associated press poll recently reporting that nearly half of the american people oppose the law. ipab, which is a critical component of the law, illustrates why those concerns are still so strong.

a separate poll confirms that opposition far outweighs support with 73% expressed concern that medicare cuts recommended by ipab could go into effect without congressional approval even if ipab's recommendations overturn a law previously passed by congress. 71% expressed concern that changes made to medicare based on ipab's recommendations cannot be challenged in court. and 67% worry that ipab could choose to limit which specific health services are covered by medicare. the american people have every reason to be worried. we should be protecting and empowering our seniors, not jeopardizing their access to health care. yet, ipab removes seniors, physicians and families were the decisionmaking process about how best to meet their health care needs. instead of giving seniors more choices, these unelected bureaucrats will take away choices from patients, from doctors and from families.

this government-knows-best approach is why americans across the country support repeal, and it's also why there's strong bipartisan support here in congress to repeal ipab. when the ways and means committee considered this legislation, we received numerous letters from groups across the nation representing employers, patients, doctors and health care professionals who voiced strong support for ipab repeal. the groups span across the political spectrum and include easter seals, the alliance of specialty medicine, the veterans' health council, freedom works and americans for tax reform. in total, 290 groups signed letters asking congress to repeal ipab, and i ask unanimous consent that these letters be submitted into the record. americans -- america's seniors deserve better. without reform, the medicare trustees say that medicare will soon go broke and not provide the benefits senior rely on.

with more and more americans becoming eligible for medicare each day, no time is more urgent than now to secure the future of beneficiaries access to care. ipab just does the opposite. it threatens seniors' access to health care and that's why it must be repealed. and, madam speaker, the republicans got it right when they named the ipab, it truly is the independent payment advisory board. it's independent from seniors, independent from people with disabilities, independent from the voters and independent from legal challenges and appeals and independent from any accountability. it's time to give that independence back to doctors, to patients and to congress by voting to repeal this washington power grab. i urge my colleagues to join me in supporting repeal of the independent payment advisory board and to vote yes on this legislation. the chair: the gentleman's request to insert documents in the record will be covered under general leave. the gentleman from michigan, mr. levin.

mr. levin: i yield myself such time as i shall consume. the chair: the gentleman is recognized. mr. levin: i hope everybody's been listening to this. what has become clear is this -- the republicans have a three-act play. first, repeal ipab. next, repeal the rest of health care reform. and finally, repeal medicare. it is so hypocritical to come forth and say that the efforts of republicans is to protect medicare when the purpose of it is to destroy it. that's what would happen if they had prevailed before. that's what would happen if

they prevail today with their voucher plan. and so the third act really came forth before the first act. so they wrote out yesterday their budget plan that essentially would repeal medicare, would destroy it. . it would be a voucher and in time, the end of medicare. essential commitment to the seniors of this country and we democrats are determined to thwart every effort. now as to the first act, repeal ipab. you know, it's interesting that medicare is a major instrument atlanta for assuring that over

time, the costs of medicare are brought under control protecting the health care opportunities of seniors. indeed, indeed there have been efforts already under the accountable care act to bring under control the costs of medicare to make sure it survives. so being an essential part of controlling health care costs over the long-term, the republican proposal essentially would go in the opposite direction. and that's why the c.b.o. last year projected and i want everybody to listen to this, the health care costs would jump by 39% under the republican plan to end the medicare guarantee.

and that's why 300 economists have said that health reform puts into place essentially every cost containment provision policy that analysts have considered. and it's because of those policies that c.b.o. has given this estimate, that ipab isn't going to be triggered until sometime after 2022. so what happens is, the republicans come forth with the repeal of ipab as a first step towards repealing medicare when they have never presented an alternative in terms of the accountable care act. so today, we hear all the scare tactics about a board whose operation effectively won't be triggered for a decade.

that's a scare tactic that is not worthy of this floor. and so, i urge very much that we oppose. you know, it's interesting that the republican budget has a cap that is more severe, if you want to put it that way, more strenuous than the provision that relates to ipab. and so they come forth and they say that ipab, which won't be triggered until 2022 is something that they should oppose. well, they want to put in place a budget this year that would a more severe cap than is in ipab. and let me also say, the notion

that there is some agency here that could act without any role for congress is simply untrue. it's not true. you shouldn't say it. we have an opportunity once ipab goes into operation to review any recommendation that comes forth and to replace it as long as the various targets are met. so i urge very much that we reject this proposal in part because the repeal in and of itself, i think, is a mistake. but mainly because what the main is here. and that has been so clear from the debate, because people who come here on the republican side, some of them talk about ipab.

some don't even discuss ipab, but talk about the accountable care act and the polling data we have is essentially relating to the accountable care act as well as to ipab. and i think the more people understand what has been going, the more they see the benefits of health care reform, the more they will be supportive of it. and we're going to take that case to the american people. let me just give you a few numbers that everyone should know about. a.c.a. it's only been two years since it was signed into law, but americans are already receiving the benefits of lower cost and better coverage. let me give you a few facts. 86 million americans have received one or more free preventative services, such as checkups and cancer screenings. 105 million americans no longer

have a lifetime limit on their coverage. 105 million americans. and up to 17 million children with pre-existing conditions can no longer be denied coverage by insurers. up 17 million kids. you repeal this act, you put them into total jeopardy. 2.5 million young adults up to 26 now have health insurance through their parentso plan. 2.5 million. you repeal if you succeed in repealing health care reform, those 2.5 million people would be out in the cold. 5.1 million seniors in the doughnut hole have saved $3.2

billion on their prescription drugs, an average of $135. if you succeeded with repeal, over five million seniors would have been essentially with increased costs. and over two million seniors have had a free annual wellness visit under medicare. already under the small business health care tax credit, over 350 small employers have used it to help provide health insurance for two million workers. and republicans come here using scare tactics about ipab. 10 years away from being triggered, according to c.b.o. and you essentially say, repeal health care reform, though you

have never had a comprehensive plan to replace it. that's been the bankruptcy of your position. the bankruptcy of your position. and you come forth, i finish reminding everybody, that we're the only industrial nation on the globe which has tens of millions of people who go to bed every day without a stitch of health insurance coverage. and the administration's brief before the supreme court has illustrated what the result is in terms of the added costs of the uninsured who go to emergency rooms. billions and billions of dollars that are essentially shifted to people who have insurance and shifted to taxpayers who have to

cover the cost of emergency coverage. so we come here with a passion. we worked hard to support and to pass this act. we worked hard to put it together. a major piece of legislation like that always needs continued work, but not its repeal. that would be a grave, grave, grave mistake. so i think it's time to pull down the curtain on this three-act play of the house republicans trying first to repeal ipab, then to repeal the rest of health care reform and then to repeal medicare. fortunately, if we're mistaken and the majority passes it here, it will deserve a death in the

senate of the united states. i reserve the balance of our time. the chair: the gentleman reserves the balance of his time. the gentleman from michigan. mr. camp: i yield myself 15 seconds just to say that our republican alternative, our republican alternative health care bill, had no lifetime caps on coverage, did not deny coverage with those with pre-existing conditions and only bill scored by c.b.o. of lowering premiums and we did it without spending $2 trillion and did not create a board of 15 unelected bureaucrats. i yield to the distinguished chairman of the health subcommittee, mr. herger. the chair: the gentleman is recognized for two minutes. mr. herger: i rise in strong support of h.r. 5. today's debate goes to the heart of the question of what kind of health care system we want to

have. house republicans believe the solution to making health care more affordable and strengthening the medicare program is more freedom, empowering innovation and competition to reduce costs and improve quality giving seniors the opportunity to choose the health care that's best for them. the independent payment advisory board, ipab, represents a very different approach to controlling health care costs. a one-size-fits-all plan in which unaccountable and unelected bureaucrats decide what kind of health care you should get. physicians, patient advocates and respected scholars, democrats and republicans alike have warned that the ipab threatens access that cares for

seniors and people with disabilities. the board has the authority to meet and make decisions in secret without considering the prospective patients and their doctors and without judicial review. madam chairman, this is the wrong approach. ipab must be repealed. h.r. 5 also includes important reforms to reduce the costs of frivolous medical lawsuits. the president's health care overhaul has not fulfilled his promise to reduce health insurance premiums by $2,500, but common sense medical liability reforms will truly bring down costs both for american families and the medicare program. i urge passage of this

legislation. the chair: the gentleman from michigan, mr. levin is recognized. mr. levin: i yield to mr. blumenauer. the chair: the gentleman is recognized. mr. blumenauer: i come to the floor from the budget committee where my colleagues are breaking the commitment we made to one another establishing a path forward on deficit reduction. it just wasn't a commitment made amongst legislative leaders, we wrote it into law and now they are breaking that commitment. they are involved with budgets that are going to actually reduce health care in this country and they would come to the floor and ask us to give exercise about something that may happen 10 years from now. i find the language curious. you could just as easily say,

instead of the supreme court, you could talk about nine unelected judicial hacks meeting in secret that have no judicial review. they are a power on to themselves. get a grip. ipab comes into play only if we are unable to deal with controlling costs. remember, the republican -- friends, i voted against it and set up the s.g.r., that we have to have a doc fix every year and cost control on automatic pilot because they didn't have it to deal with the policy changes to make a difference. for medicare, medpac which gives us recommendations, but congress blinks. well, what's going to happen maybe 10 years from now if costs

are not under control. then there will be 15 people who are experts who are recommended by congressional leaders, nominated by the president, confirmed by the senate, who will make recommendations if congress doesn't do its job. . . and then congress will be able to take those recommendations and put in place alternatives. nothing is going to happen here without congress having ability to match and do better, but because congress historically hasn't had a backbone and has failed miserablely in areas of cost control and reform, we put into the health care reform act a fail-safe, not unlike what we had to do to take base closing

out of the hands of the log rolling in congress and have a streamline procedure. this is a fail-safe. this makes sense. it's not going to happen unless congress fails in its task. i strongly suggest that what we ought to do rather than trying to unravel health care reform, on this floor and the budget committee, let's accelerate it. remember, the elements in the health care reform, when you unwind them virtually without exception have their roots in a bipartisan consensus of what needs to happen to make our health care system more efficient. many of these pilot projects, these demonstrations have actually already been at work in states across the country, including some that have republican governors.

we're doing some of it in the state of oregon. it has the dreaded mandate which was a republican think tank option that was an alternative to hillarycare 20 years ago, and in fact was put in place by governor romney who's going to be by all accounts the republican standard barrier. this is an example of congress at its worst. making up a problem, dealing with something that would help us do our job better, trying to deem onize it in a -- demonize it in a way you can virtually do with any other board or commission, ignoring the safeguards, ignoring the fact that the statute says specifically that it shall not ration, and instead they're willing to allow insurance companies to ration and ignore the need for reform. i strongly urge rejection of

this misguided proposal. let's get back to work. let's do our job. it will never come in play if congress does its job and congress will always have the last say. thank you and i yield back. the chair: the gentleman from michigan, mr. camp, is recognized. mr. camp: thank you. thank you, madam chairman. i yield two minutes to the distinguished member of the ways and means committee, the gentlelady from kansas, ms. jenkins. the chair: the gentlelady is recognized for two minutes. ms. jenkins: the president's tax health care law has null created bureaucracy -- newly created bureaucracies. but perhaps the worst is the independent payment advisory board. this board of 15 arbitrarily appointed bureaucrats is charged with slashing medicare reimbursement rates, which will drastically raise the cost of

medicine to our seniors. the ipab have no mandate to improve patient care. its mandate is to meet a budget and it may ultimately lead to the rationing of care for our senior citizens. the ipab gives these bureaucrats unprecedented power with no accountability, no judicial review and no requirement for transparency. the simple fact is the american people don't want and certainly don't need bureaucrats coming between us and our doctors. so today we ask for repeal of the ipab, but we will also make up for any amount of lost savings that the board would be able to find by strengthening our health care system with honest and straightforward medical liability reform. frivolous lawsuits have caused malpractice insurance rates to skyrocket. as a result, the price for health care patients have seen prices rise dramatically.

together, repealing the ipab and enacting these commonsense medical liability reforms, this legislation will reduce the deficit by over $45 billion, according to the c.b.o. these are commonsense, bipartisan, fiscally responsible reforms that strengthen the doctor-patient relationship and put the american people back in charge of their health care decisions. i urge all of my colleagues to support this. i yield back. the chair: the gentleman from michigan, mr. levin. mr. levin: i now yield four minutes to another member of our committee, the ways and means committee, the gentleman from wisconsin. the chair: the gentleman from wisconsin is recognized. mr. kind: madam chairman, i rise in opposition to h.r. 5. two years ago the affordable care act was passed, and i was a proud supporter of that legislation. not because i thought it was

the perfect bill. because i thought it gave us the tools and the potential to reform a health care system that was in desperate need of reform. of putting things in place that could deliver better quality of care that's given for a better price. and also increasing the access of health insurance throughout the country. to finally address the 52 million uninsured americans that we have living in our own communities. yet, the ultimate verdict on whether health care reform works or fails for those in this country is whether we can find creative ways of bringing down the costs in health care. one thing i do know under the health care reform bill that has been enacted, and in my congressional district in western wisconsin, this year alone 4,200 young adults are able to stay on their parent's health care system whereas before they couldn't. what a relief that has been to those families making sure those kids, many of whom are in school, could stay on the family plan. 5,800 seniors this year who have fallen into the doughnut hole have seen a cost savings

of roughly $610 apiece because of the 56% price discount they get under this legislation. that's not peanuts in western wisconsin. 86,000 seniors are now able to go in and get preventive care without co-pays, without deductibles, without out-of-pocket money. and 15,000 small businesses in western wisconsin now qualify for tax credits for providing health care to their employees, to make it more economically feasible for them to do what they want to do and that's provide health care coverage for their workers. that 35% tax credit goes up to 50% in 2014 when we're able to move forward on the creation of the health insurance exchanges. and 39,000 children in western wisconsin who have a pre-existing condition can no longer be denied health care coverage in their lives. this is the right thing to do. and yet we have to figure out

some cost containment measures to make sure it's sustain jblet and affordable in the future. the independent payment advisory board is a backstop in that effort. it's not the first thing we go to in order to find cost savings, but if costs do exceed target growth rates, the independent payment advisory board is able to come forward with congress with recommended cost savings that would be implemented only if congress refuse to act ourselves. and that's been the problem around here for too long. we get recommendations from med pac and other end its of where we can find savings. but because of the inability of congress to stand up to some powerful special interests, quite frankly, this institution can't by itself in order to implement those cost savings. i find it a little bit humorous that my colleagues on the other side are so fearful of this payment advise roar board making some decisions when they feel perfectly comfortable of turning this decision over to private insurance companies who are motivated by profit and trying to maximize their margin

of gain by providing health care coverage. i think that's nonsensical. but ultimately if health care reform's going to work, we have to change the way health care is delivered in this country so it's more economic or how we pay for it. so it's value and not volume-behaved any more. -- volume-based any more. getting medicare recipients in lacrosse, wisconsin, receives on average -- in la crosse, wisconsin, receives a lot of cost savings. there are studies out there showing there is every utilization in the delivery of health care which is driving up costs for everyone. if you believe the studies that are out there, and there are many, it shows that crows to one out of every three care dollars we are spending in this system goes to -- may i have one additional minute? mr. levin: i yield two

additional minutes to the gentleman. the chair: the gentleman is recognized for two minutes. mr. kind: it is going to tests, procedures that don't work. they are not improving health care. oftentimes because of the overutilization that patients are receiving, many of these patients are being left worse off than better off. we have to reform the delivery system which the affordable care act puts in place. but ultimately we have to change the way we pay for health care. we need to end and destroy the fee for service system which is all volume-based payments and move to a more of a value-based reimbursement system. the ipab can help us get to this. my own former governor, former h.h.s. secretary, tommy thompson, said repeatedly, if we do anything we have to change the payment system so making sure it's value and not volume-based.

president bush's secretary said the same thing. ipab gives us an opportunity to do that. but it's not the final say. they merely come forward with their recommended cost savings and challenges the congress to come up with an alternative cost savings. so folks, this is gut check time. this is whether we are serious about trying to bend the cost curve. their plan would get rid of medicare, turns it into a private voucher and a voucher that's inadequate to address the cost of seniors' fate. they don't reform the way health care's delivered. they are not reforming how we pay for health care. they're merely changing who pays for health care under medicare, and those costs are going to be shifted on the backs of our seniors. that's no way of reforming a health care system that's in need of reform. it only adresses the medicare portion in our budget. what the affordable care act gives us the tools to do is to reform the entire health care system, both public programs and private programs.

that's something we fundamentally have to do to get our economy back on track creating good-paying jobs. if you just repeal it now we go back to the status quo which wheens means more uninsured, higher costs and our businesses less able to compete globally. i encourage my colleagues to reject h.r. 5. i yield back. mr. camp: i yield myself 15 seconds just to say that the 15 unelected people appointed by the president, congress can't simply reject the ipab finding. congress has to reject and find those savings somewhere else within the program, unlike the base closing mission, which some members have cited. these are all people appointed by the president. so with that i yield two minutes to a distinguished member of the ways and means committee, the gentleman from minnesota, mr. paulson. the chair: the gentleman is recognized. mr. paulsen: relationship between a patient and their doctor, but the president's new

health care law, the establishment of the independent payment advisory board, this 15-member board of unelected, unaccountable bureaucrats who will soon have the authority now to dictate our nation's medicare policy by effectively deciding what health care seniors can receive. and since its inception, ipab has been the basis of vocal opposition between doctors and patients because it does threaten reduce beneficiaries' access to programs. repeal of ipab has strong bipartisan support. given the widespread concern about the impact that ipab will have to deny quality health care services, it's no wonder about 350 organizations that represent veterans, seniors, employers, small and large, as well as doctors and physicians and consumers and all 50 states support its repeal. although a majority now in congress of us support -- know

our concerns and support repeal of ipab, it's the american public, including many folks from my community who remain the most vocal about ending this program before it's implemented. and the american people have every reason to be worried about this ipab board. the unchecked powers of ipab have been explained by my colleagues already at length and simply put, ipab is a dangerous government agency that will be made up of unelected bureaucrats with no oversight, no accountability, no recourse for seniors to repeal any of ipab's decisions. the decisionmaking, the deliberations, the meetings that ipab have do not have to be held in public. madam speaker, rather than endangering medicare beneficiaries, we should be empowering them. rather than making decisions behyped closed doors, we should be having discussions in public between doctors and patients and consumers. let's repeal this provision, this overreaching provision. i yield back. the chair: the gentleman from michigan, mr. levin, is

recognized. mr. levin: i now yield four minutes to the gentleman from texas, a member of our committee. the chair: the gentleman from texas is recognized for four minutes. >> i thank the gentleman. many a american family has been recognized by soaring health care costs. we know it's been a leading cause of personal bankruptcy. we know that spiraling health care costs have been a leading cause of credit card debt. mr. doggett: and now republicans have continued their sustained effort to wreck the affordable care act. as with the republican effort, we have been witnesses at the same time that this debate is going on within the budget committee on which i also serve, the republican plan to end the guaranteed benefits of medicare, they think that our seniors pay too little and so they offer a voucher plan. . >> they tell seniors, individual

with disabilities and fish for insurance with this voucher but won't find any fish biting. that's why president lyndon johnson created medicare in the first place, because private insurance companies weren't interested in covering the old and the infirmed. well today's approach is the same approach that republicans took last year when they had their signature accomplishment right in the first month when they took over. they came out with this page and a half bill. they repealed what they said they didn't like and came forth with 12 lines with what they said they would replace the affordable health care act with. but all we've gotten since then are bills that began after they did the total repeal with repealing individual sections

like school health care clinics, like this proposal dealing with the question of health care costs. we know they don't like it. we know they don't like president obama and anything that he's for. they tell us everything that is wrong with the affordable health care act, but sure can't come up with a better idea that they have the courage to bring to a vote in the ways and means committee or bring to a vote on the floor of this house. it's all about what they are against, but have not brung any of the 12 things they approved last year in legislative form to deal with this issue of spiraling costs for our government and families or to deal with any aspect of the affordable health care act. i wish the affordable care act was good as they think it is bad. it is not. it is a compromise of a compromise and compared to the republican alternative of doing nothing and compared to the

broken health care system that wrecks so many american families that are faced with a health care crisis, this approach is far superior. the bill today that opposes this board, says, congress should be able to make these decisions. i served on the ways and means committee and health subcommittee previously for a number of years. i wish it could be so. and i think we could play a more constructive role. but frankly the history is that congress hasn't done a very good job of controlling costs and when we have taken steps to control costs as we did with the $500 billion in cost control that we put into the affordable care act that increases the solvency of the medicare trust fund by 12 years, all we have gotten is attack and criticism for the steps we took that did

limit costs. i don't view this as the best way to do it or only way to do it but when all they offer us is nothing but vouchering for our seniors, i think we should stick with the reform we have until a better alternative is presented and that alternative is not being presented tonight. republicans don't have a plan to make the hard decisions to lower health care costs. they just want our seniors and individuals with disabilities and families across america to pay more so that they can preserve all these tax breaks for the wealthiest and most successful economically people in our society and for all those corporations that export jobs abroad to continue to provide them incentives to do just that. i believe this bill should be rejected, just like their other repeal efforts until they come up and present on the floor a better idea and i don't think

they have one. they have all the retreads of the bush-cheney years. until then, i say stick with the affordable care act. i yield back. the chair: the gentleman from michigan is recognized. mr. camp: i yield two minutes to the gentleman from illinois, mr. roskam. mr. ross: did you notice something? -- mr. roskam: he was arguing from the other side of the aisle that ipab, this cost control board will never come into play as long as congress does its job. during the health care hearing that we had in the ways and means committee, the gentleman from wisconsin on the other side of the aisle characterized as ipab as a leap of faith. and we just heard from the the gentleman from texas who acknowledged it's not the best solution, so let's stick with it. here's the problem with sticking

with this failed solution. they are asking seniors to bear the brunt of this. we had an expert witness who came into the ways and means committee and i posed this question, there is no rationing per se, although it's not defined in the bill, but the bill says there can't be rationing, but can there be per se rationing, if cost -- if coverage is denied based on cost? is that rationing? absolutely, congressman. take a leap of faith, a leap of blind faith that somehow congress is going to come up with the remedy and that seniors are not going to be held at risk. the gentleman from texas said we are only here criticizing things. let me tell him madam chairman, what we are for. we are for the repeal of ipab. we are for the repeal that is going to put such downward

pressure on seniors that it will make people's heads spin. we need to empower seniors that create patient-centered health care and don't deny care and put more occupy -- out of pocket costs on the backs of seniors. i yield back. the chair: the gentleman yields back the balance of his time. the gentleman from michigan is recognized. mr. levin: you are talking about, according to c.b.o. a board whose operation would be triggered in 2022. you come here and scare people. doesn't work. you talk about rationing. you're talking about an operation 10 years from now. right now, health care is being rationed. you have 50-plus million people

who have no insurance. 50-plus million people who have no insurance at all, and you haven't come up with a bill that would address that. i now yield four minutes to the gentleman from new jersey. mr. andrews hob so key -- who has been so key in the health care debates. and i'm proud to yield four minutes to you. mr. andrews: i ask unanimous consent to revise and extend my remarks. i thank my friend for yielding and for his compliments. when our mothers and fathers go to the doctor or hospital, we want to be sure they get the best health care that can be be delivered that their doctors and families think they ought to get

and that health care should never be subject to the strategic plan of any insurance company or the whims of the marketplace, because it is not profitable as a general rule to take care of the aged and the infirmed, president johnson and this congress in 1965, created the medicare guarantee and they guaranteed that our seniors and people with disabilities would get the care they need, irrespective of the whims of the marketplace. the majority brings this bill to the floor today because they raise fears about what might happen to the medicare guarantee 10 years from now. there is a very important question about medicare before this congress, but it's coming about eight days from now, not 10 years from now, when the majority will bring yet another budget that unravels and ends the medicare guarantee.

call it what they will, when you have a system where the healthiest and the most pros prow produce -- prosperous and retirees can opt into a system, those that will be left will be the aged, infirmed and the poor and then will go to medicaid, which their budget cuts to nearly 40%, according to some estimates. and so, frankly as a diversion from the real threat to medicare, which is yet another republican budget coming to this floor eight days from now that will end the medicare guarantee. we now have a series of wild accusations about the independent payment advisory board which the congressional budget office says based upon current cost performance, would have no role for at least 10

years. so we hear all these things about these unelected bureaucrats making decisions, i would say, madam chair, and fellow house members, consider the source. two years ago, we heard that everyone in america would be in a government-run health plan if the affordable health care act passed. it hasn't happened. two years ago, we heard that every small business in america would be forced to buy unaffordable health insurance for their employees. it hasn't happened. two years ago, we heard that every american family would have to bear a crushing tax increase because of the affordable care act. it hasn't happened. two years ago, we heard there would be drastic cuts in benefits to medicare

beneficiaries because of the affordable care act. not only has it not happened, benefits have increased. seniors pay a lower share of their prescription drug costs and medicare pays more. seniors have access to annual preventative checkups without co-pays and deductibles. it hasn't happened. and finally, lest we forget, those saying ipab is a threat to medicare, said there were death panels in the affordable care act. where are they? can anyone on the other side point to one person who has gone before a government committee and been denied health care since the affordable care act as a result of that act? it's a distortion. it is a fiction, it is a distortion and here we are at it

again. now, in the first two weeks of their majority, the majority came here and made a promise to the american people. they said yes, we're going to try to repeal the affordable care act, but then we're going to replace the affordable care act. it was repeal and replace. we had the repeal as a scenario on the floor, this is just another chapter in it -- where's the replace. for the provision for people 26 and under can stay on their parents' plan, if you repeal the affordable care act, where is your bill to replace it? when it says no person can be denied health insurance if they are diabetic, breast cancer or asthma, where is their replacement? for the provision that says

seniors who fall into the doughnut hole get significant help for paying for their prescription drugs, where is their replacement? for the provision that says small business people who provide health insurance to their employees get a significant tax cut, where is their replacement? there is a saying that my friend from texas says, all hat and no horse. the majority is all repeal and no replace. so yet another example of the debate that is tired, worn out and seen its day. the affordable care act is helping to improve the lives of americans and empty political debate like this one isn't and certainly ending the medicare guarantee as the republicans will try to do in eight day is the wrong way to go. and i yield back. the chair: the gentleman yields back the balance of his time. the gentleman from michigan. mr. camp: to my friend from new jersey who says consider the

source and the source is the american people. 73% have expressed concern that the medicare cuts recommended by ipab would not only go into effect without congressional approval, but would also hurt their ability to get the medicare services they need. and i hear from my friends on the other side of how important this is to the integrity of medicare and isn't effective until 2022. and let me say with regard to the medicare cuts that are in your health care bill, most of them don't take place until 2014. and i would say that our health care bill included provisions that included pre-existing provisions and included many of the provisions -- mr. andrews: would the gentleman yield? mr. camp: i will not yield. and we did it without a tax increase and did it as the only health care bill that was scored by the c.b.o. as decreasing premiums for the american citizens and i yield two minutes to the distinguished member of the ways and means committee

from tennessee. . mrs. black: medicare's exponential growth will cause it to go bankrupt in a few years. the medicare trustees have been ringing alarm bills about their -- bells about their dwindling finances and we must act now. over 36 million americans relie on medicare for their health care and something must be done to save the program for future yen rations. unfortunately, the president's budget proposal failed to address medicare's grim future. instead, what we have in the law books now is a 15-member board that is charged with cutting costs and denying care to our seniors. the independent payment advisory bordes tab lished in the health care law would cut physician payment rates, force manage doctors to stop seeing

medicare patients. this bill makes senior care harder to access and puts bureaucrats between the patients and their doctors. it's been said today that there is not another plan. let me correct that. there is another way. there is a bipartisan way. the flarnme care that's a bipartisan proposal does not make any changes for those at or near retirement, offers grarne teed coverage options to seniors regardless of pre-existing conditions or health history and is financed by a premium support payment that's adjusted, providing additional assistance for those what are low income or less healthy seniors and more wealthy seniors -- seniors will pay. so the chiss is clear, we can continue to stick our heads in the sand and go on with a program that takes away choice for our seniors and limit theirs care and support the status quo, or we can approve a plan to save medicare and provide more choice. for me, the choice is clear. thank you and i yield back my

time. the chair: the gentlelady yields back. the gentleman from michigan, mr. levin. mr. levin: let me just say, it's strange to say you safe something by destroying it. that's 1984 in 2012. i now yield two minutes to the gentleman from new jersey. >> i ask unanimous consent to revise and extend my remarks. the speaker pro tempore: without objection. mr. andrews: i thank my friend from michigan for yielding. i want to comment on something, madam chair, that my dear friend from michigan, the chair of the ways and means committee, said. as has become part of the republican catechism, he talked about the so-called medicare cuts in the affordable care act. it is correct that in the affordable care act, we reduced medicare spending by $495 billion, by cutting corporate welfare to insurance companies, by cutting overpayments to

medical equipment suppliers and cracking down on fraud and abuse in the medicare program. the majority must agree with these ideas because in the budget they are marking up today, in the budget committee, every penny of those $495 billion in savings is included in the majority's budget. the majority must agree with these savings and i commend them for it because the budget resolution that passed here last year that essentially every member of the majority voted for, included every penny of those $495 billion in savings, i would ask my friends on the other side that if they are so in objection to those cuts, why did you vote for them last year? and why are they in your budget this year? i would be happy to yield. >> we are using those dollars to protect the medicare

program. ewe used tome this create a new entitlement. mr. andrews: reclaiming my time. because the gentleman's point was there was something wrong with the cuts. obviously he would contradict that point. every dollar of the cuts in the affordable care act have been embraced, supported, and voted for by the republican majority for which you deserve credit. the chair: the gentleman from michigan. mr. camp: i yield two minutes to the gentleman from mississippi, mr. nunnelee. the chair: the gentleman is recognized. mr. nunnelee: i thank you, madam speaker,ing that thank the chairman for his leadership in this area. i thank you for yielding. i find it fascinating as i listen to the debate that even while discussions are going on on the budget, we're hearing accusations that say that republicans want to end medicare. in reality, two years ago, when

the national health care bill passed that ended medicare as we know it. that cut half a trillion dollars out of medicare spending. that put in place this unelected group of bureaucrats that will make health care decisions for seniors. and i hear this afternoon suggestions that say, well, it may not even go in effect for 10 years. let's wait and see. we have a saying in mississippi, you know when the best time to kill a snake? the first time you see it. this ipab is a snake. and the best time to kill it is today. the club and the vehicle by which we'll kill it is this bill and that's why i'm going to vote for it an i urge all my colleagues to do the same. the chair: the gentleman yields back.

the gentleman, mr. levin, from michigan is recognized. mr. levin: it's my privilege to yield three minutes to the gentleman, mr. kline. the chair: the gentleman is recognized. mr. kline: madam speaker, my friends on the other side of the aisle want to repeal the affordable care act. since straight out repeal didn't work, they're trying to dismantle it bit by bit. i'd like to focus on the effects of the a.c.a. mr. clay: the affordable care act. on women's health. it's the greatest improvement for women's health in decades. the health care needs of women are greater. historically, women have played a central role in coordinating health care for family members. here are just some of the ways

that the a.c.a., a bill that i am proud to have helped pass, will improve women's health. women will not have to pay more than men for the same insurance policy. imagine that women will not be denied coverage because they are sick or have pre-existing conditions. that's an improvement. women will be guaranteed preventive services with no deductibles or co-pays. more low income women will have timely access to family planning services. while miracles of miracles. nursing mothers will have the right to a reasonable break time and a place to express -- express breast milk at work.

pregnant and parenting women on medicaid will get access to needed services. that would be an improvement. senior women will save thousands of dollars as reform closes the medicare scription drug coverage gap. and women will be able to comparison shop when choosing health plans for their families. family care givers who are typically women will benefit from new supports that help them care for their loved ones while also taking care of themselves. madam speaker, as a son, as a father, as an american, i strongly support the a.c.a. and its improvements to health care

for everyone, especially women, and i yield back the balance of my time. the chair: the gentleman from michigan, mr. camp. mr. camp: i yield two and a half minutes to the distinguished gentleman from the ways and means committee, the gentleman from washington state, mr. reichert. the chair: the gentleman veck niced. mr. reichert: two years ago, the president's massive health care plan came before us and then-speaker pelosi said, we have to pass this bill to find out what's in it. you know what? year finding out what's in this bill. in the last two years, we have had 47 committee hearings. we've had -- in six different committees. we've taken 25 floor votes to repeal, defund or dismantle harmful elements of this massive $1 trillion, 2,000-page government takeover of our nation's health care system. we're finding out what's in this bill. we've already repealed the 1099 requirement with bipartisan

support, we've already repealed the class act with bipartisan support, now we're awaiting the supreme court's decision on whether the individual mandate is constitutional. and i think the public is now beginning to learn a little bit about this bill themselves. i think they know there's a 3.8% tax on small businesses, our job creators. there's 2.3% tax on medical devices. wheelchairs. for our seniors, hearing aids for our disabled folks. these are things that are in this bill. there's a 40% tax on your health care plans. and now they keep telling us, too, if you like your health care plan, you can keep it. president obama himself said, you know, there may have been some language snuck into this bill that runs contrary to that premise. who do we believe here?

what do we believe? and here we are again. one more thing to add to the list of what we're finding out ismepab. the independent payment advisory board this unelected board makes decisions and gives recommendations to congress for cutting medicare payments. so this panel of unelected bureaucrats decides what kind of care is now available and allowable to our seniors, to our veterans, and to our americans with disabilities. not doctors, not nurses, not anybody. -- not anybody with medical or scientific training. these are bureaucrats. just what we need, more bureaucrats. if we don't vote to repeal this provision, a gang of 15 unelected bureaucrats will have the ability to cease -- to cause cuts to medicare payments without anyone else's input. mr. camp: i yield the gentleman 30 seconds.

the chair: the gentleman has an additional 30 seconds. mr. reichert: this will threaten access to seniors' health care in secret. there's no transparency for the bureaucrats to hold public meetings. the ipab, this board of bureaucrats, is unaccountable, it's secretive, and threatens patients' care. i yield back. the chair: the gentleman yields back. the gentleman from michigan, mr. levin. mr. levin: we're talking about a board whose operations trigger, according to the c.b.o., 10 years from now. i want to say to those who say it's unaccountable, every one of their recommendations will come before the congress of the united states. every single one. which unaccountable -- what's unaccountable are the statements that are made on this floor that are not true. i reserve the balance poff my time.

the chair: the gentleman -- mr. camp: i yield two minutes to the member of the ways and means committee, mr. brady. mr. brady: thank you, madam speaker, thank you, chairman camp. many members of congress that didn't have the time or the decision -- choice to read this new health care law before it became law, after it was passed, i asked our economist, the joint economic committee, they spept four months going through every page and provoifings the new law, to show the american public just what this new health care takeover looked like. they went through all the 2,300 pages of the bill and this is what the new health care law in america looks like. actually, not completely. we could only fit 1/3 of all that new bureaucracy on one page. here are the physicians, over

in that corner, the patients, and in between are 159 new federal agencies and bureaucrats in between you and your doctor. we can do better for the american public than this horrible health care law. and we're doing that today. today we're going to take on this chart the way it works, everything in dark blue is a new expansion of government and everything orange, potential rationing boards, everything in green is $1 trillion of new tax increases or slashing cuts to medicare, all the light blue provisions deal with expansion of government into the free market. but today we're going to act, we're not going to wait, we're going to act to repeal one of the key rationing boards, the infeint payment advisory board, you've heard today, 15 unelected bureaucrats who make life or death decisions about treatment in the future. . my mom is one of those who will

someday see her treatment limited by these unelected bureaucrats. the government will not actually say no to a senior who needs care but won't reimburse the doctor, or local hospital. i don't know what you call that, but i call that rationing. this board has unlimited power -- i will be very brief -- unlimited power to slash even more than that and congress is virtually powerless to stop it. this is america. republicans in this house are going to repeal this dangerous bureaucracy and we are when we get a chance, replacing it with affordable health care for america. i yield back. the chair: the gentleman yields back the balance of his time. mr. levin: republicans would send the decisions already there

in large measure to insurance companies. i reserve the balance of my time. the chair: the gentleman from michigan, mr. camp, is recognized. mr. camp: i yield two minutes to the gentleman from pennsylvania, mr. dent. the chair: the gentleman is recognized. mr. dent: the bill we are considering today, h.r. 5 is about patient access to care, plain and simple. in the months leading up to the passage of the health care law and since the law was enacted, congress has spent countless hours talking about the needed increase access to health care. the law is the wrong direction for our country and citizens and will negatively impact access to care. the two issues we are going to address in this legislation, repealing the independent payment advisory board or ipab and enacting meaningful medical liability reforms. now, first piece of this

legislation, ipab, let's be very clear, nothing about these advisory rulings are advisory. good luck to anybody, good luck if you try to ignore the advice of the ipab. going to be more like the medical i.r.s. than a medical advisory panel. let's be clear about the purpose, it's to save money by restricting access to health care and achieve savings by ratcheting down mamentse. this will lead to fewer doctors willing to see medicare beneficiaries and this will lead to denials of care. this board, as has been said is made up of 15 unelected bureaucrats and unaccountable ones at that. and there are no checks and balances in place to ensure that the authority is being used appropriately. this abdicates congress' responsibility. make no mistake that ipab must

be repealed and don't need a medical i.r.s. second part of this legislation is going to reform the medical liability. and this not only drives up health care costs and doctor recruitment and retention. mr. camp: i yield the gentleman additional 15 seconds. mr. dent: this has had serious implications and time we act on this issue. we train a lot of doctors, but we can't restrain them or retain them or recruit them. it's a serious problem for us. it's time for us to pass this legislation. support the legislation. i yield back. the chair: the gentleman yields back the balance of his time.

mr. camp: i yield two minutes to the gentleman from louisiana, mr. boustany. the chair: the gentleman is recognized. mr. boustany: i thank the chairman of the full committee for yielding time to me. i had a great career as a cardiac surgeon, treating thousands of medicare patients. and my career ended prematurely because of a disability. but i learned a long -- something a long time ago from my father and the most important thing he taught me, despite all the technology we have is that trust in the doctor-patient relationship is the most important thing, the most important foundation of good health care, high quality health care. look at this chart. what's wrong with this? clearly, you can see all the bureaucratic entities, but where's the doctor and where's the patient? the doctor is down here in the corner. and way off in the other corner are the patients. so all this stuff in the middle

is what undermines the trust in the doctor-patient relationship. now, we had health and human services secretary, kathleen sebelius in front of our committee recently and we were asking about this independent payment advisory board and asked the question about rationing and what came out is number one, there is no definition of rationing in the statute. so the department will have to write rules. and she admitted in committee that not going to be able to write rules that can actually protect seniors from ipab. kaiser family foundation admits that ipab must meet spending targets even if evidence of quality concerns surfaced, aarp warns ipab's medicare cuts

could, i quote, a negative impact on access to care. those are really understatements. according to medicare's own actuaries, and payments could fall less to half than medicare rates. and if left on the books, ipab will endanger the lives of seniors. it's very clear. this undermines the doctor-patient relationship and undermines trust in our health care system. it undermines quality and we will not control costs with ipab and that's why we must repeal it. i yield back. the speaker pro tempore: the chair: the gentleman yields back the balance of his time. the gentleman from michigan, mr. levin, is recognized. mr. levin: i yield myself one minute. the present system doesn't have enough primary care. i know from my own experience that there's a lack of family

physicians and primary care physicians. the affordable care act strengthens that program and will strengthen the relationship between the physician and the patient. and for anybody to come here and scare patients and seniors into thinking that there is some kind of a wall that will be replaced is really not true. >> would the gentleman yield? mr. boustany: we have a shortage of physicians in this country today. and as a physician who stays close to the physician community around this country, i'm hearing all kinds of stories about physicians nearing retirement and moving up that retirement date -- the chair: the gentleman's time has expired. mr. boustany: all of this is causing a disruption in our health care system. mr. levin: i yield myself an

additional one minute. i respect that, but the primary fact, the basic fact is that the accountable care act addresses this issue more effectively than has been addressed before. there is more money for primary care physicians, for family physicians. that's what we need. that's what we need. and to come here and raise the specter that this bill is going to diminish it when its major purpose among others is to increase the availability to have a linkage between the patient and the specialty care. mr. boustany: if the gentleman would yield. mr. levin: go ahead. mr. boustany: we have a shortage in cardio-thoacic and newero surgeons which are essential and it's getting worse.

we need to deal with this patient population. it's getting worse. mr. levin: i yield myself an additional 0 seconds. we need to address it but destroying medicare is not the way to address it. that's what you do. you destroy it. you destroy it. when you say you are saving it. i reserve the balance of my time. the chair: the chair recognizes the gentleman from michigan, mr. camp. mr. camp: i yield two minutes to the gentleman from indiana, mr. pence. pensacola i ask unanimous consent to revise and extend. i rise in support of this h.r. 5. this bill will take an important step forward in dismantling the government takeover that was passed by this body some two years ago. it would repeal the independent

payment advisory board included in obamacare and i strongly support it. now, quite frankly, the ipab that is the word that has been used on the floor of this debate is something that americans are unfamiliar with, but buried in section 3403 of obamacare, there is a powerful board of unelected bureaucrats, so-called independent payment advisory board, whose sole job would be to save money by restricting access to health care for medicare beneficiaries. that's the purpose. ipab is required to achieve specific savings in years when medicare spending is deemed to be too high and will lead to rationing and take medical decisions out of the hands of doctors and patients and will reduce patient choice. furthermore, obamacare doesn't even require that ipab do all of

this in the public domain. there is no requirement that ipab hold hearings or meetings, consider public input or make its deliberations open and to the public. unaccountable washington bureaucrats meeting behind closed doors to make decisions that should be made by patients and doctors is unacceptable in this ipab must be repealed. you know, it was two years ago that we passed this government takeover of health care into law and important to note that the first act in this congress in january of 2011 was a full repeal of obamacare. you'll never convince me that the federal government -- mr. camp: i yield to the gentleman an additional 30 seconds. pensacola i thank the gentleman. you will never convince me that the federal government has the authority to order the american people to buy health insurance

whether they want it, need it or not. my hope is in the days ahead, the supreme court will come to that conclusion. i believe we must not rest or relent until we repeal obamacare lock, stock and barrel, but for now let's take the path before us. let's repeal this independent payment advisory board once and for all. and i yield back. the chair: the gentleman yields back the balance of his time. mr. levin: you ready to close? i yield myself the balance of my time. the supreme court will be hearing the case about the individual mandate next week and i don't think we want to argue this now. we don't have any judges here. but let me say on the individual mandate, it really is ironic

that the more conservative apparently your the more you dislike the individual mandate. when individual mandate was the central point within the health care reform proposal of conservatives in this country several decades ago, it was their central point in the 1980's and in the 1990's and now they've reversed course and claim what they propose in the 1970's and 1980's, was constitutional then is unconstitutional today. talk about a flip-flop. that is, i think, maybe an unconstitutional flip-flop, but the court will decide that. let me just say a word about

cost containment. and the importance of our addressing that. and the importance of our reforming the present system, how we reimburse the fee-for-service system. and i don't think it's been noticed, in addition to ipab, a.c.a. has a number of provisions that will go into effect long before ipab could become operational. and those systems are beginning to work. and for conservatives who talk about the importance of cost containment, they want to repeal an act that has within it not only the siege of cost containment, but the instrumentalities and they are beginning to work well enough and that's why c.b.o. says it is

going to be 10 years before ipab is triggered. . . those who come and claim to be concerned about cost containment essentially are undermining their own position. well, this is act one of the republican three-act play. the second is to eliminate health care reform altogether, and the third is to take away medicare. and i want to close reporting the views of aarp in terms of the ryan budget proposal. it says, and i quote, it looks balance, jeopardizes the health and economic security of older americans, end of quote. quoting again, a number of

proposals in this budget put at risk millions of individuals by prioritizing budget caps and cuts over the impact on people, end of quote. and those who talk about the cap that would essentially be within the structure of ipab's operation, that proposed cut is less than in the ryan budget. which would be more severe and essentially the implementation would be by insurance companies who are nameless, who are unaccountable, so let me continue with another quote from the aarp. by creating the premium support system for medicare

beneficiaries, the proposal is likely to simply increase costs for beneficiaries while removing medicare's promise of secure health coverage, a guarantee that future seniors have contributed to through a lifetime of hard work. and then they finish, the premium support method described in the proposal, unlike private plan options that currently exist in medicare, would likely price out traditional medicare as a viable option, thus rendering the choice of traditional medicare as a false promise. thus rendering the choice of traditional medicare as a false promise. so this is what i think we should do in terms of this

three-act play of the house republicans. and that is to start by re-- by rejecting act one, this repeal of ipab. this isn't -- this may be a vote but it's not going to be an act. i finish with this. in a sents, you are acting because this isn't going to become law. you have not come up in all of these months with a comprehensive alternative to the affordable care act. there's not been a comprehensive bill put forth. we haven't voted on a comprehensive bill in these days on the ways and means committee. instead, there has been a piece by piece effort to dismantle what was health care reform to address a serious situation

including over 50 million people who go to sleep every night without health care coverage in the united states of america. we should be ashamed of that. we should be ashamed. and a couple of years ago, we acted to lift that shame off of the shoulders of all of us in the united states of america. i urge we vote no on this bill. the chair: the gentleman yields back the balance of his time. the gentleman from michigan, mr. camp is recognized. mr. camp: i yield myself the plans of my time. the chair: the gentleman is recognized. mr. camp: nearly 70% of seniors are worried that ipab will limit their medicare choices and the coverage available to them under medicare. i think this is the most troubling part of the health

care law that the democrats rammed through the congress and that is because this secret rationing board is given enormous power with no accountability. the ipab allows, the 15 unelected board members of ipab are free to cut reimbursement rates for certain procedures or services they deem unnecessary. and they can cut those rates so low that physicians will no longer be able to offer those services. that's pretty clearly the ability to ration. we've had countless position groups warn us about the ipab, warning us that these cuts will force them to stop seeing medicare patients, and the real problem is because tricare reimbursement rates are tied directly to medicare that we'll have health care for our military personnel negatively

impacted by the ipab as well. the democrats gave ipab blanket authority to operate in secret. there's no requirement that their deliberations, their reasonings for their conclusion must be made public. and also, the health care bill states directly that ipab, and i'm quoting here, may accept, use, and dispose of gifts or donations -- donations of services or property. that's not a very subtle invitation for lobbyists and others with interests in issues before the congress to impact these unelected and unaccountable ipab members with cash, with gifts, with other items. so not only do they have enormous power, that if the congress can't override automatically becomes law. but they have the ability to do

it in secret and the legislation states directly that they can accept gifts and donations. this is a troubling piece of obamacare that we need to repeal and i urge my members to vote for repeal of this. i yield back the plans of my time. the chair: the gentleman yields back the balance of his time.

the chair: does the gentleman from texas seek to be recognized? >> madam chairwoman, i yield myself such time as i may consume. the chair: the gentleman is recognized. mr. smith: america's medical liability system is broken and in desperate need of reform. frivolous lawsuits drive physicians out of the practice of medicine. limitless liability discourages

others from high-risk medical specialties and substantially increases the cost of health care. the solutions to this crisis are both well known and time tested, but the president's recent health care legislation did nothing to address the problems in our medical liability system. you cannot wait any longer to fix the problem. you should pass this bipartisan medical liability reform legislation to cut health care costs, spur medical investment, create jobs, and increase access to health care for all americans. h.r. 5, the health act, is modeled after california's decades-old and highly successful health care litigation reforms. according to the national association of insurance commissioners, the rate of increase in medical professional liability premiums in california since 1976 has been nearly three times lower than the rate of increase

experienced in other states. by incorporated california's time-tested reforms at the federal level, the health act saves taxpayers billions of dollars, encourages health care provide tors maintain their practices, and reduces health care costs for patients. it especially helps traditionally underserved rural and inner city of communities and women who seek obstetrics care. reforms in h.r. 5 include a $250,000 cap on noneconomic damages and limits on the contingency fees lawyers can charge. it arows courts to require periodic payments for future daniels in order to ensure that patients receive all the damages they are awarded without bankrupting the defendant. it also provides provisions that create a fair share rule by which daniels are allocated fairly in direct proportion to fault and it provides reasonable guidelines on the

award of punitive damages. the health act allows for the payment of 100% of payment's economic losses. these unlimited economic damages include all their medical costs, their lost wages, their future lost wages, rehabilitation costs and any other economic out of pocket loss suffered as a result of a health care injury. the health act also does not preempt any state law that otherwise caps damages. this bill is a common sense and constitutional approach to reducing the cost of health care. whereas the health act allows doctors to freely practice nationwide, the obamacare individual mandate dictates that all people buy a particular product whether they want it or not. unlike obamacare, the health act saves american taxpayers money. the congressional budget office

recently determined that the president's health care law will cost almost double its original $900 billion price tag. another c.b.o. report estimates that premiums for medical malpractice insurance ultimately would be an average of 25% to 30% below what they would be under current law. these are just a few reasons why organizations like americans for tax reform support this legislation. the health act also reduces the cost of health care as it decreases the waste in our system caused by defensive medicine. this practice occurs when doctors are forced by the threat of lawsuits to conduct tests and prescribe drugs that are not medically required. according to a harvard university study, 40% of medical malpractice lawsuits filed in the united states lack evidence of medical error or any actual patient injury. 40%.

many of these suts amount to legalized extortion of doctors and hospitals. but because there are so many lawsuits, doctors are forced to conduct medical tests simply to avoid a lawsuit in which lawyers claim that, quote, not everything possible was done for the patient. this wasteful defensive medicine adds to our health care costs without improving the quality of patient care. in his 2011 state of the union address, president obama said, quote, i'm willing to look at other ideas to bring down costs, including ones that republicans suggested last year -- medical malpractice reform to rein in frivolous lawsuits, end quote. let's help the president keep his words and put this legislation on his desk. madam chairwoman, i reserve the balance of my time. the chair: the gentleman from

michigan, mr. conyers is recognized. mr. conyers: thank you, madam speaker. ladies and gentlemen of the house, when we passed the landmark affordable care act, some who derisively term it the obamacare, i believe that someday of this bill will be famous because it's named after a president, we were proud to have taken up a step, an important step, in realizing a goal that we've been striving for for quite a long time. but today, we're confronted with a leader in the house himself -- in the house, himself a medical doctor, who is urging that we take a step backwards and roll back our

progress. . the measure before us will repeal the independent payment advisory board, which would save us millions of dollars and pay for itself by pushing through malpractice legislation that undermines state sovreignty and enriches corporations that surely don't need it. now, congress established the advisory board to slow medicare's growth costs. the independent payment advisory board does not undermine our role in medicare policy, nor

does it cut access to care. its repeal, however, removes crital oversight and efficiency and paves the way for the majority's plans to replace guaranteed health care for seniors with corporate voucher systems. how many of us have constituencies that you can go back home to and tell your constituents that you're going to replace this health care bill that is praised from one end of the country to the other, that has taken decades to enact, that we're now going to use vouchers for health care? please. i'm going to at this point,

reserve my time, madam speaker. the chair: the gentleman reserves the balance of his time. the gentleman from texas is recognized. mr. smith: madam chairwoman, i yield such time as he may consume to the jutch california, mr. lungren, senior member of the judiciary committee. it the chair: the gentleman is recognized. mr. lungren: the notion that 15 unelected members have been empowered by the affordable care act to ration care for seniors and that's for all seniors is or wellian as the previous congress to divert attention to what's being done hire. delegating to a government board to make decisions with such a dramatic impact on the health care alternatives available to medicare recipients raises the most serious ethical concerns about the respect of dignity for our seniors. this is the unfortunate

consequence of a world view which favors the notion of bureaucratic efficiency as the solution to the challenges facing our health care system today. the purpose of providing quality health care to our nation's seniors is simply incompatible with the idea that health care can be achieved through a panel of experts. rather than empowering seniors to play an active role, the ipab moves in the opposite direction by empowering an unaccountable government panel to make these decisions. in this regard, the inclusion of legislative language to repeal ipab could not be better placed than with a medical liability reform bill because ipab itself is malpractice. there are important reforms concerning our health care system. these reforms are modeled after

my own state's reforms. this was signed into law three decades ago by then and now again california governor jerry brown. i practiced under this law for several years. i practiced under the law that preceded micra. i did a good deal of medical malpractice defense in the courtroom. i appeared before juries and judges and i settled cases. i had the opportunity to defend doctors and hospitals. about 90% of the cases i did were on the defense side. about 10% on the plaintiff's side. i believe i had the first successful medical malpractice suit against a -- against an

h.m.o. in the state of california. i had an opportunity to view the system close up. and the fact of the matter is, without the micra reforms, the california health care system would have collapsed. we had doctors leaving the state of california, particularly in specialties such as object stetics and gynecology, neurosurgery and moving to other states because the premiums required to be paid by our doctors had become so exhorbitant and had to leave the state or no longer practice medicine. information received by our judiciary committee from the national association of state insurance commissioners indicates that since 1976 when it was adopted, california's medical liability premiums have

risen than less than half the pace of the rest of the country. i would caution that it should not be perceived as a silver bullet but it is a positive step forward taken by our state and a sound model for reform. this is evidence that laboratories of democracy that states serve as incubators of reform. at the same time, i do believe it is important to recognize that the american legal system contains issues unique to the states which operates within the context of federalism. in this regard we need to be cautious on the federal level of making assumptions on the impact of our actions. in california, the effort to adopt a federal medical liability reform has raised questions. even though one aspect of the i am pet tuesday behind h.r. 5 is to bring medical practitioners

from the trap of defensive medicine by the chairman of our committee, physiciansr unfortunately, are expressing some concern. the california medical association, while they support getting rid of the board as we previously discussed, have expressed some opposition to the fair share rule contained in section 4-d of the health act. they expressed that it will preempt law and put patients at risk and inform us that the fair share rule will increase the potential for physicians to face enforcement proceedings against their personal assets and will force physicians to purchase increased medical professional liability coverage which will increase liability premiums in california for physicians. secondly, the california medical association has expressed serious concerns with granting

complete immunity to device manufacturers and distributors and suppliers. they worry that this will force plaintiffs to look only to physicians and other providers to seek relief and will increase physician exposure and liability costs. so i'm on the dilemma here. i do believe that we absolutely, as the physicians of california medical association believe ought to rid ourselves of the independent payment advisory board for fear that its implementation will, in fact, interfere with the doctor-patient relationship, interfere with the vailt of medical care, interfere with the availability of physicians to seniors, and others. but they have expressed some concerns about the attempt that we have to give other states the

benefit of micra and i understand some of their concerns. i think we may very well be able to address that in further language. so it is my intention to vote for passage of h.r. 5. but before it would return to us from the senate, we would specifically address the concerns brought up by the physicians of my state. this is an important reform. some of these others contained in the further section of the health care act warrant support, but i do believe we need to have some changes and i would look forward to those changes in a conference report or any bill which is returned to the body by my -- by the senate. i would like to say this, for someone who practiced law for a number of years, in the area of medical malpractice with doctors and hospitals and saw what a

failure to limit noneconomic damages was doing to the availability of health care, not just the cost of health care, but the availability of health care in my home state, i do believe micra is a model that ought to be replicated by other states in the union. i do believe the facts are in. over 30 years we have been able to see it has improved access to health care, improved to the number of physicians, particularly in difficult specialties and it has brought down the overall cost of premiums and therefore, the cost of medical care in my state. the idea that somehow medical malpractice premiums have no effect either on the cost of care or the accessibility of care, flies in the face of the experience of 30 years in my home state of california. and with that, madam speaker, i

would yield back. the chair: the gentleman yields back the balance of his time. the gentleman from michigan, mr. conyers. mr. conyers: madam speaker, i'm pleased now to recognize the former speaker of the house, our leader, nancy pelosi, for one minute. the chair: the gentlelady is recognized. ms. pelosi: i thank the gentleman for yielding and i appreciate his leadership to help us honor what our founders put forth in our founding documents, which is life, liberty and the pursuit of happiness, and that is exactly what the affordable care act helps to guarantee, a healthier life, the liberty to pursue happiness, free of the constraints that lack of health care might provide to families. if you want to be a photographer, a writer, an

artist or musician, you can do so. if you want to start a business, if you want to change jobs under the affordable care act, you have that liberty to pursue your happiness. and so that is why i'm so pleased that this week we can celebrate the two-year anniversary of the affordable care act. and i want to mention some of the provisions that are in it. but not before mentioning that the legislation on the floor today is a feeble attempt to unravel legislation that makes a big difference in the lives of america's families. you be the judge. if you are a family with a child with asthma, diabetes, has a pre-existing medical condition, up until this bill, your child could be discriminated against

for life of ever receiving affordable health insurance and therefore, care. but already, even though the full thrust of the law does not take place until 2014, right away from months now, to no child in america can be denied health coverage because of a pre-existing condition and soon all americans will have that same protection. for the first time in american history, millions of american women and seniors have access to free preventive health services. services that prevent better early intervention to detect a possible illness in a person. 86 million americans have already received key preventive health benefits under the law.

and more than five million seniors have saved $3.2 billion in prescription drug expenses. already, $3.2 billion in prescription drug benefits because of provisions of the law that are already in effect. so if you're a senior and caught in the doughnut hole, you are already benefiting from this law. and that's what the republicans are trying to take away from you, from your family, from your life, from your liberty, from your pursuit of happiness. the last point about seniors and prescription drugs is particularly important because it fits in with our consistent commitment from day one, as authors of medicare in their 60's that fits with our consistent commitment to always

strengthen medicare for american seniors, never weaken it. indeed, as i mentioned, democrats created medicare, sustained medicare and democrats will always protect medicare even from language that is so misleading as to make one wonder. . republicans, on the other hand, have voted to end medicare. they have said their goal for medicare is for it to wither on the vine. tonight's legislation is a part of the withering on the vine. it's important for you to know that if you care about medicare, you depend on medicare. this is the wither on the vine scenario. just, in fact, yesterday, republicans released their budget which would end medicare guarantee, shift costs to

seniors, end the guarantee, what does that mean? shift costs to seepors, perhaps up to $6,400 for most seniors a year, and again, let medicare wither on the vine. that's why today's legislation is such a cynical, political ploy and i know that america's seniors will not be fooled by it. today, republicans have brought to the floor legislation that is known as -- to repeal what is known as ipab, independent payment advisory board. independent. independent of political influence over decisions that are made. this piece of the legislation was to bepped the curve and reduce the cost of health care in america. republicans are just desperate to distract seniors from their real record on medicare and that's what they're trying to do today. i say that without any fear of

contradiction, without any hesitation, because nothing less is at stake than the well being of our seniors. their health, their personal health, their economic health and that means their security. further, in this bill, republicans have recycled their old medical malpractice liability legislation that undermines states' rights and hurts the rights of injured patients to obtain just compensation. i can put more in the record but i'll just say this, because of the impact on american states of what they're trying to do in this bill, the bipartisan, and i repeat, bipartisan national conference of state legislatetures, has strongly opposed this bill. that bipartisan group says that after a careful review, it had reached, quote, the resounding bipartisan conclusion, their words, that federal medical

malpractice legislation is unnecessary. again, mr. speaker -- madam speaker, this week we celebrate the two-year anniversary of the affordable care act for what it embodies. it's about innovation. it's not just about health care in america but a healthier america. it's about prevention, innovation, customized, personalized care, it's about electronic medical records, it's about lowering costs, expanding access, and improving quality. so much misleading information is put out there about it, but it's important to keep repeating the difference, think transformative nature of the legislation, in fact, it has already begun to transform the lives of america's children by saying no longer will they be denied coverage because they have a pre-existing medical condition and soon we can fully say that no longer being a

woman is a pre-existing medical condition where women are discriminated against to the tune of $1 billion a year in cost of premiums, not to mention exclusion from obtaining coverage. so i proudly celebrate the two-year anniversary and i am emphatically oppose the legislation on the floor. if you want to unravel medicare, vote aye. if you want to support medicare, if you think shk a right for the many, not just a privilege for the few, vote no. with that, i yield back the plans of my time. the chair: the gentlewoman yields back. the gentleman from texas is recognized. mr. smith: i yield myself such time as i may consume. the chair: the gentleman veck niced. mr. smith: most americans oppose obamacare yet support medical liability reform of the

kind we are considering tonight. a recent survey found that 83% of americans believe that reforming the medical system needs to be part of any health care reform plan. as the associated press recently reported, most americans want congress to deal with malpractice lawsuits driving up the cost of medical care, says an associated press poll. yet democrats are reluctant to press forward on an issue that would upset a valuable political constituency, trial lawyers, even if pd barack obama says he's open to changes. the a.p. poll found that support for limits on malpractice lawsuits cuts across political lines, with 58 pk of independents and 61% of republicans in favor. democrats were more divided but still 47% said they fare making it harder to sue while 37% are opposed.

the survey was conducted by stanford university with the nonprofit robert wood johnson foundation. in the poll, 59% said they thought at least half the test doctors order are unnecessary, ordered only because of fear of lawsuits, end quote. in a poll done by the health collation -- coalition on liability and access in october of 2009, 69% of americans say they wanted medical liability reform included in health care reform legislation. 72% said that their access to quality medical care is at risk because lawsuit abuse forces good doctors out of the practice of medicine. mr. chairman, let's support a bill that is so strongly endorsed by the american people. i reserve the balance of my time. the chair: the gentleman reserves. the gentleman from michigan is recognized.

>> i recognize the gentleman from the judiciary committee, jerrold nadler, and i yield to him as much time as he may consume. the chair: the gentleman is recognized for two minutes. mr. nadler: i thank the gentleman for yielding and rise in opposition to this deeply flawed and deceptively named legislation. contrary to the bill's title, it will not promote access to better health care nor will it make health care more affordable. if the wishes of many of the proponents of this legislation come true and the affordable care act is repealed, the medicare and medicaid as we know them are curtailed or eliminated, then decent, affordable health care will remain out of reach for millions of americans, including many who have access to health care services now. i urge members to keep one fact in mind as we debate the

aspects of this bill. these provisions apply only to people who have meritorious claims of malpractice against them you don't have to limit people's recoveries for people out those claims. so what we are doing will only be to those who have been injured, whose injury was inflicted by someone else's wrong doin, and who need and should be entitled to compensation. the argument we hear is if we allow the players in the health care industry, including big pharma, manufacturers of medical devices and even big insurance companies and h.m.o.'s who refuse to pay for service, if we allow them to escape from the harm they inflight, we'll all be better off. this is not true and has never been true and despite the extravagant plays of the bill, that will not be true of this multibillion dollar gift if

this were to become law. how pricey a gift to industry are we talking about here? according to the congressional budget office, $45.5 billion over the next decade. anyone who believes that those savings will be passed along directly to consumers or to health care providers and victims of medical malpractice is living in a dream world. some of us will remember the debates we had in this house for the eight years preceding enactment in 2009 -- of 2005 of the bankruptcy code rewrite will no doubt reremember the argument that abuse of the bankruptcy system was a hidden tax for every american and tightening the rules would be in the interest of all americans. we passed that huge giveaway to the big banks. consumers have not seen a nickel of that $400. the banks pocketed all the money. if you think this bill will lower costs for consumers, that the big insurance companies will not simply pocket the money, there's a famous bridge in my district i might be

willing to sell to you. keep in mind just who will be bearing the burden of this legislation. people are subject to limitations on damages and on their inability to pay and their inability to obtain competent counsel, something not imposed on insurance companies or drug companies or h.m.o.'s. it may be good for the insurance companies, manufacturers of goods and medical quices and other wrong doers walking these halls with open checkbooks but it comes at the expend of their victims. nowhere does c.b.o. or the sponsors explain why they believe that the companies will pass any savings along nor do they account for the cost of care needed by people who are injured and will be unable to receive adequate corp. sation. the gentleman from -- this bill is not limited to suits against individual health care service providers. for doctors and other licensed health care professionals. it it would provide protection

against malpractice claims for large corporations, health maintenance organizations and pharmaceutical giant whence they deal in defective products or someone else's health is destroyed because an insurance company refused to pay for necessary care. mr. speaker, we heard the gentleman from california refer to the california legislation that is the model for this legislation passed in 1976, 30 -- what is that? in 36 years ago. that legislation enacted a limit and said for noneconomic dammings you could only get a recovery of $250,000 because you lost a leg or they removed the wrong leg or whatever. they failed in -- they felt in 1976 that $250,000 was an appropriate amount. in today's dollars that's $38 thourblings but there's no innator in that legislation, no inflator in this legislation.

if that $250,000 in 1976 today is $13479 million so if we were modeling this on that, we should say the limit is $1.4 million. but we're not doing that. we're saying $250. and we're not putting adjustment in there, so $250 this year, five years from now, the equivalent of $100,000, and eventually zero. i submit it is very wrong. it it may be that if malpractice causes a woman to lose her fertility, causes her to lose her ability to bear children, the medical costs to her may be minor. the lost wages, economic dams may be minor but the inability to bear a child, that should be limited to $250,000 and eventually to almost nothing because there's no inflation in this? if someone is put in a wheelchair for life, the pain and suffering is worth almost nothing? that's what is wrong with this legislation. that's what is immoral about this legislation.

that's why we've got to vote against this legislation. i yield back. the chair: the gentleman yields back. the gentleman from texas is recognized. mr. smith: i yield five minutes to the gentleman from illinois, mr. johnson. the chair: the gentleman is recognized for five minutes. mr. johnson: mr. speaker, members of the house, first of all, let me thank the chairman for his willingness to allow me to speak on an issue in which we do not agree. i appreciate the courtesy, i appreciate the lively debate that has preceded me and probably in a far more articulate way than i'm going to be able to articulate. let me just, mr. speaker, members of the house, address this issue in a bigger sense an then in a more specific sense as a member of the united states congress. to begin with i believe that this addition is largely unrelated an almost entirely disconnected from the underlying bill. i believe it demonstrates some

concern, i believe it reveals some lack of concern for sensitivity and i think in a lot of ways reveals the duplicitousness that i think is inherent in an issue, in a discussion of this issue. i think it is antithetical to our beliefs, at least my beliefs and i think most members on this side of the aisle as to what america is all about. i look at this have from the standpoint of a republican member a republican party who has been a forerunner as -- has dealt with the issue of states' rights and has attacked this health care bill, the attorneys general on the states rights an interstate commerce basis. it is a classic example, mr. speaker, members of the house, as to what has historically been an area for states' rights, whether it's the criminal justice or domestic law or civil justice, our founding fathers set in place a

federal level and state level government an this strikes at the core of states' rights. in addition to that, members of house, mr. speaker, separation of power. we have been critical with respect to h.r. waivers granted. we have been critical of the e.p.a., u.s. d.o.t. and others for their administration and promulgation of rules without legislative authorization. yet this entirely desecrates in some way ours whole judicial function. our judicial function by which liability and damages and intrusion into judicial arena is something that's been sacrosanct and i think it's esen torble our viewpoint of ha the constitution is all about. i, have having been involved both from a number of standpoints, see a system that an overwhelming number of cases works to affect justice. two attorneys or more,

witnesses, jurors, a judge and the common law of 200 or 250 years, almost inevitably results in justice results. and now we have a situation, despite that commitment to free market that we have, where we're now proposing that the federal government dictate to override this whole system that's already in place and i think infringes on our constitutional right to a trial by jury. and it also strikes, i think, mr. speaker, and members of the house, at what we republicans say we believe in terms of individual worth. one of our tax quite frankly on the passage of this bill which i largely subscribe to are ones that deal with the depersonalization of the individual's int herent in president obama's health care approach. it is a collectivist, this bill, a collectivist attack on personal realities and disregard for age, circumstances, state or community residence and i think that addresses a in a very serious way the concept that we have constitutional worth of the individual. in conclusion, this bill has

essentially nothing to do with revenue production. we all know that. it object advice cates the underlying purpose of the bill which is quite frankly to dismantle the bureaucracy in the health care bill which i largely subscribe to. it injects politics into a legitimate debate on a substantive public policy and prevents republican and democrat members from an up or down vote and strikes, i think, at the -- our fundamental believes of states' right, of individualism and on constitutional premises. in summary, i believe that a no vote is a vote to preserve individual dignity. our no vote is one to maintain constitutional values and it is to safeguard states' rights and separation of powers. i know this is well scombended but n.s.p. -- this is not the -- intended but this is not the vehicle to do it in. the vehicle is austin, texas, or albany, new york, or springfield, illinois. i have some serious concerns about state legislation that would also interfere with separation of powers but this is not the arena to do it in.

it is not the bill to do it in. and i think quite frankly it is one that unfortunately for me strikes at the core of why i'm here. i'm not here to dismantle our common law system. i'm not here to dismantle the free market system. i'm not here to dismantle states' rights. i'm here to stand up for what i think the american people sent us here for. i don't think the health care bill was well considered. i think it should be substantially addressed in terms of this and other legislation but this bill doesn't do it, ladies and gentlemen. and i, with all due respect, ask my colleagues on both sides of the aisle to join with me in a no vote on what i think is maybe well intended but certainly misdirected effort and i join with my colleagues over here and some over here in urging a no vote. thank you. the chair: the gentleman's time has expired. the gentleman from michigan is recognized. mr. conyers: mr. speaker. could i ask if the distinguished gentleman from illinois, mr. johnson, would like additional time? if he requires any, i would be

glad to arrange to yield him further time. mr. johnson: what was the -- i'm sorry. oh, you wanted to know if i want more time? mr. conyers: i said, if you require more time, i would be delighted to yield it to you. mr. johnson: you're very kind to do that, mr. conyers. i think i probably pretty well addressed it and i think between myself and my inarticulate comments and your opposition and some opposition over here, i think the debate has been very good and good for the process and this is one i'm with you on, sir. mr. conyers: i thank you, mr. johnson. the chair: the gentleman from michigan is recognized. mr. conyers: mr. speaker, i am pleased now to recognize the judiciary committee member from florida who's worked very carefully with us on this subject matter, ted deutch, and i yield him four minutes. the chair: the gentleman is recognized for four minutes. mr. deutch: thank you. thank you,. mr. chairman, it's no surprise

-- thank you, mr. chairman. it's no surprise that i'm disappointed with the content before us today, adjoined with my colleagues who have expressed their disappointment. but i'm also disappointed with the process behind it. yesterday for a totally bogus reason the rules committee declared an amendment i offered out of order. they claimed it would add to the cost of the bill, despite having no numbers. the amendment did not create some new regulation. it did not create new judicial proceedings. it did not set aside money for a new program. let me tell what you it did do, mr. chairman. it would have made a terrible bill slightly better. it's simple. my amendment ensures that doctors who intentionally, not accidentally, but intentionally harm their patients are not exempt from medical malpractice liability. if this congress wishes to tell

a child made blind by the negligence of his doctor that those in this chamber know better than a jury, if my colleagues wish to pretend that the seventh amendment of the united states constitution, guaranteeing a trial by jury, was somehow omitted from the bill of rights, i disagree. but so be it. the very least we can do is ensure that if a doctor intentionally abuses his patients, that he will not evade justice. surely the sponsors of this bill did not intend to extend liability caps to a pediatrician who sexually abused a child or a dentist who raped his patients

under sedation. i'm disgusted to say that those of -- those are both real examples of the kind of abhorrent behavior h.r. 5 may mistakenly immunize without clarification. is it too much to ask that we simply think this through? can someone explain to me how this amendment costs a penny? better yet, will someone explain to the 103 children who were molested by a delaware pediatrician that washington wants to make it easier for sexual predators to evade justice. my friends, differentating between med car errors and intentional harm is not -- medical errors and intentional harm is not some idea being peddled by the left. many states, blue states, red states and in between, limit malpractice awards but make distinctions for intentional torts.

the majority could have considered my small change and protected the commonsense state laws that are already on the books. instead, under the 112th congress, relentless partisanship has poisoned this well and impeded our ability to write good laws. perhaps, mr. chairman, perhaps the reason the americans are so disenchanted with congress is because they know that it doesn't have to be this way. i urge my colleagues to vote no on this legislation and i yield back the balance of my time. the chair: the gentleman yields back the balance of his time. the gentleman from texas is recognized. mr. smith: mr. chairman, i yield myself such time as i may consume. the chair: the gentleman is recognized. mr. smith: mr. chairman, lawsuit abuse drives doctors out of their practices. there's a well documented record of doctors leaving the practice of medicine and hospitals shutting down, particularly

practices that have high liability exposure. this problem has been particularly acute in the fields of ob-gyn and trauma care as well as in rural areas. the absence of doctors in vital practice areas is at best an inconvenience, at worst it can have deadly consequences. hundreds or even thousands of patients may die annually due to a lack of doctors. according to one state study, 38% of physicians have reduced the number of higher risk procedures they provide and 28% have reduced the number of high risk patients they serve all out of fear of liability. the american college of obstetricians and gynecologists has concluded that the current legal environment continues to deprive women of all ages, especially pregnant women of their most educated and experienced women's health care providers, end quote. the study from northwestern university school of medicine

polled residents and found that many wished to leave the state to avoid its hostile malpractice environment. the study concluded that, quote, approximately 1/2 of graduating illinois residents and fellows are leaving the state to practice. the medical malpractice liability environment is a major consideration for those that plan to leave illinois to practice, end quote. without a uniform law to control health care costs, many states will continue to suffer under doctor shortages. and, mr. chairman, i'll reserve the balance of my time. the chair: the gentleman continues to reserve. the gentleman from michigan is recognized. mr. conyers: mr. speaker, i am pleased now to recognize the distinguished gentleman from georgia, a member of the house judiciary committee, for as much time as he may consume. the chair: the gentleman is recognized for as much time as he may consume.

mr. johnson: thank you, mr. chairman, and thank you, mr. speaker. today, mr. speaker, i rise in opposition to this harmful bill, this harmful bill, h.r. 5, the so-called protecting access to health care act. now, this bill is premised upon what i will call a story because that's what my mama used to tell me, my mama and my grandmama used to say, you know, that's wrong to say that someone is lying, don't say that. you say that they're telling a story. and so i grew up plagued with the guilty that comes from calling somebody a liar and i still have that -- i still have that sense of shame and so

associated with that word liar and i'm not hure to accuse anybody of lying -- here to accuse anybody of lying, but i will say that h.r. 5, the so-called protecting access to health care act, is a story. it's premised on the story that runaway frivolous lawsuits, medical malpractice lawsuits are a major cause of driving the cost of medical care through the roof. and that's not true. this bill restricts a patient's ability to recover compensation for damages caused by medical negligence, defective products and irresponsible insurance companies. it also sets a cap of $250,000 for noneconomic compensatory

damages which are awarded to victims for emotional pain and suffering, physical impairment and disfigurement. and i am so sorry to have not had this photograph blown up. it's a photo of caroline palmer of marietta, georgia. ms. palmer was in an automobile accident back on march 23 of 2007. she sustained two broken legs, a broken shoulder, abrasions on her arms and a collapsed lung. while she was at the hospital recuperating, they noticed that her left hand was swollen, dusky blue and cool to the touch. but after so noting on her medical record, the doctor left

work that day and no further action was taken about that. that was a clear sign that blood was not flowing to that limb and that something was wrong. nothing was done. no follow-up. the next day they found that the i.v. line had been misplaced in her arm and they referred her in for some treatments to try to reinvigorate the circulation in that arm and there was nothing they could do. they tried everything, they even subjected caroline to a procedure on both arms to

relieve the pressure and treat the loss of circulation by producing a large gaping hole in both arms. that procedure failed, whereupon she was then suggested to the cutting off of her left arm and the cutting off of her right arm. we have talked a lot about well, how much is a leg worth? how much is a beg worth when you lose a leg? well, how much are two legs worth? how much are two arms worth? this picture shows carolyn palmer in this horrendous state and under this amendment, under this bill, h.r. 5, this woman, victim, would be limited to $250,000 for her pain and

suffering and disfigurement. that's not right. how do you put a cap on someone's pain and suffering? how heartless is it to cap noneconomic damages when one has lost a limb, becomes blind, how much is vision worth? how much is the ability to see, how much is that worth? $250,000 under this legislation. if you become paralyzed at the hands of the negligent health care provider, can no longer walk, how much is that worth? $250,000. these caps hurt the most vulnerable among us, children, senior citizens, and working poor. they can't even recover for economic losses such as lost wages.

they may not be working, a child doesn't work. a child left with no arms is limited in noneconomic damages to $250,000 for the -- that's going to handle him, he's got to roll with that for the rest of his life. $250,000. it's not right. medical malpractice is about real people with real injuries. the institute ofed me sip estimates that 98,000 people die each year in the united states from preventable medical errors. tort reform proposals such as h.r. 5 fail to address the deaths an injuries associated with preventable medical errors every year this h.r. 5 is an

unholy alliance between two stories, the one story which i just outlined to you and the other story being the repeal of the 15-person independent payment advisory board, also known as ipab, which was created under romney care -- oops. i mean obamacare. oops, i mean the affordable care act. now, why -- while i do believe that there are some good reasons to be opposed to the ipab and to vote to apolish -- abolish it, i believe there are some good reasons for that, but rationing of medical care is not one of them. anyone who says that, anyone

who says that this ipab board has the power to cut the benefits paid to medicare recipients has either not read the bill is -- or is telling you a story. now, just for the record, i want to read 42 u.s.c. section g 1395kkk. and i'm not going to comment on the k.k.k. right now. but that's the subsection of the subsection of 42 u.s.c. where the law that was passed, romneycare. i mean obamacare -- i mean affordable health care act is stated, the law, 2 u.s.c. and

it says the proposal shall not include any recommendation to ration health care, raise revenues, or medicare beneficiary premiums under section 1818a, or 1839. increase medicare beneficiary cost sharing, including deductibles, co-insurance and co-payments or otherwise restrict benefits or modify eligibility criteria. that is what obamacare -- romneycare -- i mean the affordable health care act provides for. that's the law. anybody who tells you otherwise

is telling you a story. now, i understand, going back to the first story, i really oppose it for the reasons that i previously stated. this pill is another example of the republican majority bringing a partisan bill to the house floor that has virtually no chance of becoming a law. h.r. 5 does not create any jobs or grow the economy. it's a slap in the face also of states' rights, something we've heard that the other side has

depended on for a long time. state's rights. the 10th amendment. h.r. 5, ladies and gentlemen, denies states their right to have their own tort laws, state of georgia, for instance, in its constitution, says that all citizens are entite told a jury trial. the legislature imposed a $350,000 cap on noneconomic damages in medical malpractice in other cases, case went up to the judge, the supreme court -- to the georgia supreme court which ruled that to limit noneconomic damages deprives one of their constitutional right to a jury trial. this bill, h.r. 5, would do away with what the georgia supreme court has ruled

insofere as georgia law is concerned and it's a greas overstepping of federal -- it's a gross overstepping of federal legislation into the affairs of the state and i oppose it and i understand that there was a meeting yesterday, a special called meeting that majority leader eric cantor called of the tea party republican caucus to kind of tighten some screws and twist some arms to get the caucus to go along with h.r. 5 so that no one would get embarrassed. it's yet to see what will happen but i believe that all of the tea party republicans will fall into line and vote in favor of h.r. 5 which has absolutely no chance of passing once it goes to the other body.

so i want to thank the chairman , ranking member of judiciary, john conyers, for giving me this time and i will yield back the balance. the chair: the gentleman yields back the balance of his time. the gentleman from texas is recognized. mr. smith: i'm meezed to yield such time as he may require to the gentleman from georgia, doctor gingrey, who happens to be the sponsor of this the legislation we're considering tonight, the health act. the chair: the gentleman is recognized for such time as he may consume. mr. gingrey: i thank the chairman of the judiciary committee for yielding to me and the opportunity to follow directly my colleague from georgia on the other side of the aisle a number of things were said and i feel grateful to have the opportunity to address those. one of the comments that the

gentleman made, the gentleman is my good friend and he would agree with that, but in regard to this emergency caucus meeting with the tea party caucus on the republican side with our majority leader, eric cantor, i am an original member of the tea party caucus in the house of representatives. if there had been any emergency called meeting, mr. chairman, i can assure you that i would have been right with michele bachmann and steve king and others 20, of us, that were original members of the house g.o.p. tea party caucus. there was no such meeting. let me refute that statement. although i greatly respect anymy friend from georgia, from dekalb. in regard to the issue -- i'll be glad to yield to my friend.

mr. johnson: i certainly don't want to misstate what actually happened and i think i said that it's my understanding that that meeting was held, that's information that i received. mr. gingrey: reclaiming my time, the gentleman did say that. he say it was his understanding, he didn't state it as a matter of fact and appreciate that comment but another thing, mr. chairman, that i want to address, he talked about, and he named names, i think the lady's name was ms. palmer, out of marietta, georgia, i live in marietta, georgia, and have for the last 36 years. i represent marietta in the 11th congressional district, have for the last nine and a half years the description of this unfortunate soul's injuries and the things that happened to her, the broken bones, the collapsed lung, the lack of blood flow to the extremities because of improper

placement of an introvenous line, instead of maybe in a vein or artery, that resulted in amputation of her upper extremities, you know, these -- when the general public hears stuff like that, mr. chairman, they're horrified and to think that we on this side of the aisle with h.r. 5, the health act, which is part of the path act, that we are discussing on the floor today, to suggest that a person that suffers like that could only recover $250,000 in noncompensatory pain and suffering is absolutely untrue. the gentleman, my friend from dekalb, is an attorney. he knows the legal system.

he's been in the courtroom. i'm not sure whether he's tried on the side of the plaintiff or the defense in regard to medical malpractice cases but he clearly knows the difference in noneconomic pain and suffering in regard to this particular bill and on the other hand recovery for severe losses, medical compensation, loss of wages, loss of extremities, what this poor soul suffered. let me just read, mr. chairman, this comment. nothing -- nothing -- in the health act denies injured plaintiffs the ability to obtain adequate redress, including compensation for 100% of their economic loss,

essentially anything to which a receipt can be attached, and believe me, plaintiff's attorney will attach every receipt including the medical cost, the cost of pain relief med case, the loss of wages, their future lost wages, rehabilitation costs and any other economic out-of-pocket loss suffered as a result of a health care injury. economic damages include anything whose value can be quantified, including lost wages, home services, an au pair, a companyian to go shopping, medical costs, rehabilitation of a home, access for someone who is -- has an incapacity, an inability to access a normal home, so you know, the gentleman just like

the gentleman from iowa the plaintiff's attorney, that spoke on the floor earlier, in regard to misleading statements, to suggest that in this legislation, we would take away a person like ms. palmer of marietta, georgia's, ability for a full and complete redress of grievances, a medical practitioner or facility has performed below the standard of care far local community. my colleague, the chairman of the judiciary committee, the distinguished chairman, gave me some statistics in regard to some of the economic losses that people have incurred and judgments have thank have been warded by -- judgments that have been warded by a jury of their peers.

listen to this, mr. chairman. in august of 2010 a judgement for $5 million. riverside county, these are california cases, by the way, mr. chairman. and it's california law that h.r. 5 is based on. micra passed back in 1976. but these are cases in 2010. this one in february of 2010. riverside county, $16,500,000. november, 2009, los angeles county, $5 million. october, 2009, sacramento county, $5,750,000. and i'll go down to the last one, although there's several others on the list, july, 2007, los angeles county, an award of

$96,400,000. this, mr. chairman, is in 2007. micra was passed in 1978. this case in 2007, this plaintiff may have been awarded $250,000 noneconomic, because there was a cap. but the cap is there not to deny them their day in court, their ability to be judged by a jury of their peers and a decision made in regard to just compensation. there are 21 members of the house g.o.p. doctors caucus. it includes 16 physicians, a psychologist, several dentists, several registered nurses and

i'll guarantee, mr. chairman, in every one of these cases that i mentioned coming out of california, we'd be sitting there fighting for those plaintiffs. we would be sitting there fighting, maybe even a witness, for the plaintiff. for ms. palmer. to say the sky is the limit and mr. plaintiff's attorney, you tack on every economic cost that you can dream up and we'll vote in favor of it. but what we are opposed to, mr. chairman, is this opportunity for people to come into court and clog up the court system and crowd out ms. palmer and maybe many of these cases from california with frivolous lawsuits, where there's no justification for the claim, where people are just hoping with a lottery mentality that

some sympathetic jury would just simply say, oh, gosh, you know, we know there's no damage here but after all, the doctor has $10 million worth of insurance, it's not coming out of his pocket. so, you know, let's award the plaintiff $6 million or $8 million worth of noneconomic, pain and suffering if you want to call it that, damages. that's the thing that's got to stop. that's what's causing the price of health care to rise astronomically. that's why doctors are ordered -- have ordered all these unnecessary tests, prague practicing defensive medicine -- practicing defensive medicine. every time a patient comes to the emergency room with headache, even though the doctor is skilled in physical diagnosis, in taking a history and examining that patient, and looking at their eyes and making sure there's no bulge of the pupils or the optic disk, they

know that patient has a tension headache, they know it's perfectly safe to send him or her home with a prescription to return in 24 hours. but, no. because of these frivolous lawsuits they're going to order a cat scan that costs $1,500. you multiply that time and time and time again, that's what this is all about. that's the problem we're trying to solve. and for my friend from detab, and he is my great -- dekalb, and he is my great friend, or my friends from iowa, are indeed the former -- or indeed the former speaker, the minority leader, ms. pelosi, to come to the floor and very eloquently and she is eloquent and speaks with a lot of passion, great ability, great communicator, but to mislead is down right wrong.

the truth needs no adjectives, mr. chairman. mr. johnson: would the gentleman yield? mr. gingrey: the path act, i say to my colleagues, we need to pass this and do this in a bipartisan way and not worry here about what's going to happen in the senate. let's do the right thing in the house of representatives and let's do the people's work. and with that i yield back. the chair: the gentleman yields back the balance of his time. the gentleman from michigan is recognized. mr. conyers: mr. speaker, i yield myself one minute to ask my friend and distinguished medical practitioner and member of congress, mr. gingrey, is he aware that his bill, h.r. 5, eliminates several liability for both economic and noneconomic damages? and i yield to the gentleman for

that purpose. mr. gingrey: well, i thank the gentleman for yielding. and it gives me an opportunity to explain and i'm sure the gentleman, it's his time, i appreciate him yielding. in regard to joint and civil liability, mr. chairman, it's important for our colleagues on the house floor and anyone within ear shouting distance to understand what we're talking about in regard to joint and several liability. under current law, under current law anyone who is named as a defendant and a medical malpractice suit -- in a medical malpractice suit is liable for whatever judgment is rendered. it matters not how much they participate in the case. let me give my good friend from michigan, the ranking member of the judiciary committee, an example. of course he knows this.

let's say it's an ob-gyn case and the surgeon who has done a hysterectomy on friday is going to church on sunday morning and asks his colleague to stop by and see the patient and to tell her that he'll be around that afternoon to check on her. and the doctor says, sure, i'll be glad to, peeks his head in the door. mrs. jones said, i'm fine. ok, your doctor will be around this afternoon to check on you. things go to heck in a hand basket, the operating physician maybe has practiced below the standard of care. but that doctor that covered, that peeked in the door, that had really nothing to do with the case, surely as mr. conyers knows will be named in the lawsuit and if he or she happens to have the deepest pockets under current law, they could be liable for the entire judgment. whereas the doctor who practiced

below the standard of care, who has a shallow pocket, would get off. so i yield back to my friend and i thank him for the opportunity. mr. conyers: i yield myself an additional minute and i thank dr. gingrey for his response. did i understand, i asked the author of this bill, h.r. 5, that the answer to my question of whether h.r. 5 eliminates joint and several liability for both economic and noneconomic damages is yes? mr. gingrey: the answer is yes. mr. conyers: i thank the gentleman very much. mr. speaker, i am now pleased to recognize the gentlelady from houston, texas, ms. sheila

jackson lee, for as much time as she may consume. the chair: the gentlelady is recognized for as much time as she may consume. ms. jackson lee: let me thank the ranking member and also the chairman of the judiciary committee and the leadership for giving us the opportunity to celebrate as we debate h.r. 5, celebrate the affordable care act. two years in the making. clearly it speaks to where we are today. so in celebration of the affordable care act, let me

first of all wish it a happy anniversary. and before i start on affordable care act, let me indicate to my friend from georgia and the physicians caucus that many of us do not take a backseat to our support for physicians. how can i help myself, coming from a community where the texas medical center is? fighting for a permanent doctor fix, which we have not been able to secure from this congress, and as well-being a champion of physician-owned hospitals because i do believe that physicians have a high level, an accuseness of their concern for their patient. and maybe it is also because in the last decade i've had to tend to ailing parents, both of whom i lost, and have seen doctors up close and personal dealing with

one of the most difficult times in any child's life. so this is not about a fight of one side or another regarding doctors. and my constituents have been kind enough to give me time here to have gone through these debates over and over again. so let me just say very quickly, i am glad the affordable care act is in place because what we're celebrating today, as we talk about h.r. 5, is that women will not be dropped from insurance when they get sick or pregnant, insurance companies will not require women to obtain pre-authorization for referral for access to ogbyn. million of older women with chronic conditions will not be banned from care. 279,000 constituents in the 18th congressional district will have improved employee health care. 187,000en insured in the 18th congressional district will now have access to health care and

my hospitals, my public hospitals, my texas children's hospital, st. luke's, methodist will be able to secure compensation in uncompensated care. i celebrate the affordable care act. but today we are discussing legislation that has already received a veto notice from the president. but we're here on the floor of the house discussing h.r. 5 and ignoring the fact that the affordable care act has already confirmed health care is vital to america and we in congress must protect it. by the way, affordable care act is a preserver of medicare and strengthens medicare. but let me tell you what we are facing with this legislation that is anchored with the component dealing with medical malpractice. we have seen documentation ss