the speaker pro tempore: on this vote, the yeas are 416, the nays are zero. 2/3 being in the affirmative, the rules are suspended, the bill is passed, without objection the motion to reconsider is laid on the table. the unfinished business is the vote on the motion of the gentleman from california, mr. royce, suspend the rules and agree to h.res. 348 as amended on which the yeas and nays are ordered. the clerk will report the title of the resolution. the clerk: house resolution 348, resolution supporting the right

of the people of ukraine to freely elect their government and determine their future. the speaker pro tempore: the question is will the house suspend the rules and agree to the resolution as amended. members will record their votes by electronic device. this is a five-minute vote. [captioning made possible by the national captioning institute, inc., in cooperation with the united states house of representatives. any use of the closed-captioned coverage of the house proceedings for political or commercial purposes is expressly prohibited by the u.s. house of representatives.]

the speaker pro tempore: on this vote the yeas are 413, the nays are 4. 2/3 being in the affirmative, the resolution is agreed to and without objection the motion to

reconsider is laid on the table. for what purpose does the gentleman from mississippi seek recognition? >> i ask unanimous consent that the committee on house administration be discharged from further consideration of s. 2162 and ask for its immediate consideration in the house. the speaker pro tempore: the clerk will report the title of the bill. the clerk: senate 2162, an act to establish a 10-year term for the service of librarian of congress. the speaker pro tempore: is there objection to consideration of the bill? without objection, the bill is read a third time and passed and the motion to reconsider is laid on the table.

the speaker pro tempore: the ouse will be in order. he house will be in order. the house will be in order. the chair will entertain requests for one-minute speeches. for what purpose does the gentlewoman from florida rise?

ms. ros-lehtinen: i ask unanimous consent to address the house for one minute and revise and extend my remarks. the speaker pro tempore: without objection. observation. the gentlelady is recognized for one minute. ms. ros-lehtinen: thank you so much, mr. speaker. i rise -- the speaker pro tempore: the house will be in order. the gentlewoman's recognized. ms. ros-lehtinen: i rise today to congratulate edward jhudack on being sworn in this past friday, october 16, as the chief of police for the coral gables police department. he has a long record of service for south florida having worked 26 yoors for the city of coral gables, helping residents and visitors alike in the city beautiful, a city that i'm humbled and honored to represent. the chief is a proud university of miami hurricane. the chief earned his undergraduate and masters agree

from the u and having recently graduated from the f.b.i.'s national law enforcement en executive academy. e has a hard working and civil servant. congratulations on being named the top cop of the city beautiful, the si of coral gables. thank you, mr. speaker. the speaker pro tempore: for what purpose does the gentleman from arizona seek recognition? >> permission to address the house for one minute. the speaker pro tempore: without objection. mr. gallego: guy i rise today to celebrate the 25th anniversary of the white house initiative for hispanics. for 25 years, the initiative has played a role in advancing the policies that helped our

community move forward. this year, the initiative released the bright spots in education initiative. the catalog features 230 programs and organizations and initiatives that are supporting d investing in educational achievements. i recognize four in my district. the american dream academy, the byling equal nursing program, the head start program and the victoria program. they are leading the way to close the educational gap. they find ways to nurture every child to have the tools they need to succeed. thank you. the speaker pro tempore: for what purpose does the gentleman from minnesota seek recognition. mr. paulsen: permission to address the house for one minute.

the speaker pro tempore: without objection. mr. paulsen: i rise today with a heavy heart to honor stephen sandberg who was killed last week. he was deeply respected by his community and someone who was handling the county's toughest cases which meant putting himself in harm's way. he was a dedicated family man and a committed parent, not missing one of his daughters' basketball games. he was a shining light. a former three-sport athlete and served as a volunteer firefighter and taught sunday school. he dedicated his life to serving others. we honor his sacrifice and our thoughts are with his wife and daughter and the entire community. at this time, i yield back. the speaker pro tempore: for what purpose does the gentleman from california seek recognition? >> permission to address the

house for one minute. the speaker pro tempore: without objection. without objection. >> i come here to remind us how diverse our country is and how beautiful it is we have been celebrating hispanic heritage month for the last 30 days. i wanted to take the opportunity to remind everybody that when we do things like that, it's not how to talk about how separate we are but how wonderful and great our country is. the people that come from all over the world, all over the world to start a new life. who come here. mr. cardenas: and together, we have created the greatest country that this world has ever known and ever seen. from europe, from the americas, from africa, from australia, from all parts of the planet, people come to this country for

a better life and a second chance. and i hope and pray that in these chambers, we can live up to the responsibility of holding true the values of america and hold our legislative body of this country to create and pass laws and make sure that everybody can continue to have those opportunities for generations to come. thank you very much. i yield back. the speaker pro tempore: for what purpose does the gentleman from pennsylvania seek recognition? mr. thompson: request unanimous consent to address the house for one minute and revise and stepped. the speaker pro tempore: the gentleman is recognized for one minute. mr. thompson: thank you, mr. speaker. rise today to recognize elk county, pennsylvania commissioner. it was awarded outstanding commissioner of the year. this award recognizes a commissioner that contributed to the advancement of community

government. june has a long-term, totalling 24 years. she has been a leader in issues from human services, prison issues, infrastructure improvement, recycling and environmental issues. specific accomplishments during her tenure include the centralized and improvements to the county jail. as you know, mr. speaker, county commissioners across the country dedicate countless hours towards the improvement of the communities and counties and i know her work proves this true in elk county. and i yield back. the speaker pro tempore: for what purpose does the gentleman from new hampshire seek recognition. >> permission to address the house for one minute. mr. guinta: permission to

address the house for one minute. . mr. guinta: i thank the new members of the bipartisan task rce to combat the heroin epidemic. heroin abuse in the united states has increased 63% over the last decade. this dangerous drug has torn a path through every community, destroying families and ruining lives. in my home state of new hampshire, the number of patients admitted to the state-funded programs reached over 1,500 doubling the number in 2004. nationwide in 2014, heroin abuse was responsible for 8,200 deaths. the number of addicts has doubled. to address this health crisis, we must expand coordination between law enforcement agencies and medical professionals and assemble the best ideas. congresswoman kuster and i

formed the bipartisan task force and we are raising awareness, increase education and hear from families and individuals affected by the spread of heroin. stop this epidemic and i yield back. the speaker pro tempore: for what purpose does the gentleman from minnesota seek recknegs nigs. >> address the house for one minute. >> allow me to congratulate the minnesota links basketball team. this wonderful basketball team has won three titles in five years. this is the great sports story of our time and i would like to know the coach and the fans know that we are incredibly proud of them. mr. ellsworth: we had a vick -- mr. ellison: we had a victory parade and this is women's basketball, it is high quality and shows girl that women are

excellent athletes. this is great for our whole country and great for our country. we are proud of the minnesota linx. go minnesota linx. the speaker pro tempore: for what purpose does the gentleman from california seek recognition? >> permission to address the house for one minute. the speaker pro tempore: without objection. the gentleman is recognized for one minute. >> yesterday the treasury department confirmed what we already knew. we cut the federal deficit to the lowest level. mr. lamalfa: it is lower than 2014 and less than one-third of what it was in 2009. yet earlier the administration was quick to boast the deficit being down that low. what is the plan, mr. president, for balancing the budget. when? we haven't gotten an answer.

this is a discipline started by house republicans with the budget control act and other measures to keep spending in line but we will have a truly balanced budget. if we had the economy, things to help spur the economy, we could reach that goal by 2019 with the right discipline. then, no longer will we have to have a debate should we be expanding the bebt limit, which is appalling for us. so this is indeed good news. we want to get that budget deficit number to zero and maintain the business of this country. i yield back. the speaker pro tempore: for what purpose does gentlelady from texas seek recognition? ms. jackson lee: i ask unanimous consent to address the house for one minute. i'm very excited today to

congratulate the researchers from the baylor college of medicine and rice university in my hometown of houston. on monday, they announced an important discovery about the structure of human genetic material and advanced that one day could enable that could lead to disease. this was in the journal of the proceedings of the national academy of science, the ought thors included experts from stanford and harvard. brought about this particular research and described the research of a six-foot-long of d.n.a. strain. but the main excitement about this is to the many children, to the many young people, to the many families who suffer the loss of a child from a deadly disease, we have research that may alter that process and

impact, if you will, the genetic impact of the dap that results in diseases that causes the death of our children. let me congratulate rice and baylor universities and we look forward to saving lives from houston, texas. i yield back. the speaker pro tempore: the chair lays before the house the following personal requests. the clerk: leaves of absence requested for mr. hudson of north carolina for today and mr. payne from today through october 23. the speaker pro tempore: without objection. the requests are granted. under the speaker's announced policy of january 6, 2015, the gentleman from california, mr. garmeppedy, is recognized for 60 -- garmeppedy, is recognized for is recognized for

60 minutes as the designee of he minority leader. mr. garamendi: this is chaos week in washington, people want to talk about benghazi or the next speaker or the last speaker. what i'd like to talk about is chaos in america's infrastructure system. earlier this morning on my way to the airport in sacramento, i was drives up interstate 5, a highway that connects mexico and canada and oregon and washington and california. and i hit a huge pothole. and another pothole. the entire right lane was a series of potholes for the nine miles i traveled to get to the airport. not unusual. but that's the story of america's infrastructure. this great nation and everybody

here on the floor when they talk want to talk about how this is the world's most vibrant economy, the place where intellectual infrastructure takes place. but it's certainly not the place where physical infrastructure takes place. we rank 16th among the developed nations in the world on our infrastructure. travel to china. high speed rails going every which way. new airports. remember the comment of our vice president when he flew into la guardia in new york city. wasn't very complimentary. we have a need to fill the infrastructure -- a need to build the infrastructure of this nation because it's upon the infrastructure that the economy grows. it's upon the highways that we travel and move the goods and services. it's upon the transit system that more than 45% of americans depend on their transportation.

we've got problems. i was reminded of apollo 13 and that very famous quote coming back from space. houston, we've got problems. yep. america, we've got problems. that's a picture of the bridge on interstate 5 in washington state, just a little bit north of this bridge is the canadian border. this bridge collapsed about three years ago. there are 63,500 bridges in america that are deficient. and over the last decade, we've seen americans die on bridges that have collapsed. we've got a problem. given ng other things,

all the chaos here in washington, we've got a problem with infrastructure. and the house of representatives is going to take up an infrastructure bill this week in committee. we'll talk about that a little later. but first i want to go through some of the other problems besides bridges and highways, h, by the way, it would take $780 billion to bring our highways up to adequate standards. that's a lot of money. maybe it's not. that's about three quarters of what we have spent in afghanistan over the last 14 years. i guess we make decisions about here where we spend money. in f our highways are inadequate condition and congestion abounds in 42% of the urban highways. yeah, we've got problems. we can solve them. we'll see whether the house of representatives and the transportation infrastructure committee is willing to solve the problems this week when we

take up the infrastructure bill in the house of representatives. one of our other problems i'd like to have my colleague from california, representative janis hawn address, a problem -- janis hahn address, a problem she's particularly aware of, she represents the greatest port in america, the port of los angeles and its neighboring part, the port of long beach. representative hahn. ms. hahn: mr. garamendi, thank you for devoting this special hour to the needs that we have in this country when it comes to our infrastructure. so i'm sort of excited because this week, at long last, barely in time before the highway trust fund runs out of money, we're finally going to look at the

long-term surface transportation bill to fund some of our nation's most critical infrastructure, which you've been talking about. our nation's highways, our roads, our bridges, they've been neglected far too long and today, we, unfortunately, have an infrastructure crisis. and not only do the american people rely on these roads to get from point a to point b safely and efficiently, our economy relies on them as well. i've been advocating, as you know, for more funding for our freight network. that's the series of highways an roads that go from our ports and our manufacturing hubs and that vast majority of our nation's freight travel on. our nation's ports are hard at work bringing in cargo from all over the world and exporting the products of american manufacturing to the growing overseas market.

22 million jobs nationwide rely on the efficient movement of goods in and out of our ports. these jobs rely on our nation's freight network. but for too long, we failed to invest in this important infrastructure and allowed toyota crumble. too many bridges along the freight network are in disrepair and too many of our highways are unable to handle the modern levels of traffic. now many of us deal with the inconvenience of traffic every day but this same traffic also costs both businesses and consumers money. and it threatens our economy's ability to stay competitive in the 21st century global economy. as the roads on our freight network become more and more unreliable, the cost of transporting these goods increases and american manufacturers and consumers pay the price. that's why i propose legislation that would drastically increase the funding of this freight

network infrastructure. i thought it would be a good idea, and my bill would have used existing custom fee -- customs fees to provide $2 billion every year just to fund this freight network and the infrastructure project without, by the way, raise anything taxes. and i thought by assessing our freight -- our freight network we could give american manufacturers a competitive edge and spur the economy. the highway bill we're considering this week provides just $768 million per year in freight funding. less than half of what i was hoping for. but it's a start. i hope we can continue this conversation and find ways to invest in our ports and in the freight network at the level that our economy needs. so i hope that in coming days we can work in a bipartisan way to

improve the highway bill and ensure that it passes before the end of this year. i would like to see the freight network expanded to include that last mile. those are the roads that connect everything to our ports with highways and with rail and when we talk about improving our roads, these last mile roads are often forgotten even when they have the greatest amount of traffic. i hope we can expand the freight title to include funding for on dock rail at our ports, investing in on dock rail would actually ease traffic on our highways by taking a will the of those trucks off the road and that cargo would come off the ships, go right another the rail and then to the end consumer. so this bill is a positive step, not perfect, not as good as i would like to have seen, but it is the right step for a long-term plan to invest in our nation's critical

infrastructure. i am looking forward to working with you, john, thank you for your leadership on this, thank you for talking about why make it in america makes sense. but none of that makes sense unless we can finally invest in this infrastructure, in this country, to, as you said, make this country great and make it work for everyone. so thank you for doing this tonight. i yield back. mr. garamendi: representative hahn, your leadership on port issues are well known. caucus herethe port house of representatives, you're constantly badgering all of us about the necessary i have to ports being expanded. we know the eastern ports are facing the challenge of providing access for the panamax ship, bigger ships being able to go through the panama canal. we know on the west coast, as you've told us, we need to improve the infrastructure on the west coast for the

efficiency so we can keep the panamax ships on the west coast. the freight issue you talked about so eloquently here is absolutely on. it is the major part of the american transportation economy. we look at roads, we look at railroads but the notion of combining this into a comprehensive strategy in which we talk about the movement of goods, the freight movement. your leadership is very, very important. i thank you so much for joining us. i know you have a tight schedule for the evening but you broke away to bring us a very, very important message. thank you so very, very much. i want to continue on here ally with the ports -- engineers does a report card on the american infrastructure. we would fail. we would have to go back to remedial classes if their report card was somehow the way in which we were judge -- the way in which we would judge the work

of the united states congress because with regard to ports, as we just discussed, it's a c. even though progress has been made. but to meet the needs of the ports, we're going to have to spend an additional $46 billion over and above what is already programmed. to meet the needs of the highways. it's $748 billion in the future in order to meet the needs of the highways. and that just gets us out of the d rating provided by the american society of civil engineers. for transit, it's also a d. as i said earlier, some one-half of american households depend on transit because they don't have a car. so 45% of the urban passengers cannot get the services they need from transit. it goes on and on and on. bridges, a c-plus, as i said earlier. 63,500 bridges are inadequate.

and for the rail system, part of what congresswoman hahn was talking about, the railroads have invested over $75 billion of their own money improving their systems but the intermodal programs that are so necessary require that those rails connect to the highways, to the trucking industry. and that hasn't been done. so the rails actually receive a c-plus ranking. we've got work to do here. we've got some very, very serious problems. let me just put this up because there are solutions available to us. if we take a look at the problem, in this case, global assessment of the united states is 60 for transportation infrastructure. the solution, invest. for every $1 we invest, the economy grows by $3.54. so you put $1 in and suddenly

you get the economy moving. people go to work. for every $1 billion we invest in roads and bridges, we're going to create 21,671 jobs. those are people that are getting good, high quality, high paid, middle income jobs. and guess what, they're going to pay tacks. so you invest $1 and get back $3.54 of economic activity and get tax growth. not new taxes. but new people paying taxes. that's what we want. we want people to go to work. we want jobs in america. and so when we find that if we invest in infrastructure, we've got the opportunity to create jobs, to increase the tax base and grow the economy. now, on the negative side, under investing in infrastructure costs america over $-- over 900,000 jobs.

including 97,000 jobs in manufacturing. these things go together. we have fortunately had over the years a buy america requirement in the infrastructure financing, for highways and bridges and the rest and for transit. that your tax dollar,000,000 tax dollars, all of our tax dollars are required to be used to buy american-made goods, equipment, services, buses and the like. unfortunately, it's only 50% system of transit agency can take your tax money and spend 50% of that tax money on buying a bus or a train from china and the other 50% presumably would have to be spent on american-made services and goods. not good enough. i think it bought to be 99%. why not use our tax money to buy american? so these are the opportunities and the problems that we have available to us.

and that's the large outsourcing i just talked about. and the solution? make it in america. i talked about that for five years here on the floor. build the american economy with a make it in america -- with make it in america laws and regulations. use our tax money to buy american made goods and quipment. here's what it means. i'll give you a couple of examples. the good news and the bad news. here's why make it in america strategies are important. the bad news is california. my home state. here we had to rebuild the oakland-san francisco bay bridge . it fell down during the 1989 earthquake and now and then we decided we had to rebuild it.

it takes a long time how to rebuild it and how it's going to like. ke and what it was and someone decided that it would be cheaper to buy chinese steel than american steel. so they contracted with a chinese steel company. the result was 3,000 jobs in china, a brand new steel mill to manufacture the most high-quality steel and what the chinese sent to america was deficient. the welleds were insufficient. he result was at least part of that problem was $3.5 billion overrun. that's the bad news. california really screwed up. we say, make it in america. guess what happened on the other side of the continent.

new york. new york needed to rebuild a new ridge, the new york tapanzee bridge. it was made with united states -manufactured steel. 7,728 american jobs because they undertook a buy america requirement and they bought it in america, on time, under budget. the tapanzee bridge, good. the oakland-bay bridge, bad. i want to move on to where we are this week. on october 29, the united states congress will engage in its favorite game, kicking the can down the road. we will take up a transportation infrastructure bill this week.

good for us. several months late. not in time for next week's deadline and so we'll kick the can down the road and give ourselves a couple of months to ponder how we can address the needs of america's infrastructure. i want to suggest to you there is a way we can do it. and i put this chart up to challenge all of us. this chart displace the opportunity as well as the potential for the missed opportunity. there are three new infrastructure pieces of legislation that are floating around the united states capitol. but before we go to those three, i want to call your attention to where we are today. highway funding. this is today's highway funding.

we are spending somewhere around 264 billion on highways. $64.2 billion on transit. the entire amount over a six-year period of time. this is six years, $319 billion. this does not include the rail system. $319 billion is what we are spending over a six-year period of time. i have said how inadequate that is and i won't go back to that again. now the administration proposed, but frankly never pushed, never put any weight behind it. and i think copped out on what is, in my view, a very, very good bill, a comprehensive bill that included rail transit. again, not included here. it had $499 billion, not included the rail, compared to

the $319 billion that we are spending today. that amounts to $120 billion a year more. actually, $130 billion a year more. that's good. that's what we need. i misquoted, $130 billion over six years. that's the kind of money we need to build the infrastructure. highways, $317 billion over six years compared to where we are today, $246 billion. significant increase, enough to fix the potholes on i-5. today, 64 billion over six years. the entire sum, $449 billion compared to $319 billion over six years. that's the kind of progress that we can and must make if we want to move from 16th among the

world's economies, developed economies, to get back up into the top five. that's what we need to do. this does not include the rail transit. you add the rail transit, the numbers are bigger. the united states senate, what did they do, $276 billion ompared to $246 billion. and that's $10 billion, better? but not enough. we need over $115 billion. the entire sum on the senate $361 ot including rate is billion compared to $319 billion. better? but not enough. not sufficient, to build the infrastructure that this economy and this society needs to move out of 16th place.

now, where's the house of representatives? this week, we are going to take up a bill that is less than the senate bill and just little bit better than what we are doing today. if you are happy what we are doing today, you will love the house bill. if you want to deal with congestion and deal with ports and trades and move from a d to a b or an a, you don't do it with the house bill. this is the starting point and beginning of negotiations. why in the world would you begin negotiations at the bottom when you need to get to the top? beats me. i don't get it. we've got toll build the american infrastructure. it is how we move our economy. it's how we move people back to work. good middle-class jobs.

it's how your tax money should be spent. and how can we raise the revenue for this? well, we don't need to increase the gasoline or the diesel tax. keep it the same. no increase. people can argue that it should or should not be increased. but you don't need to. this proposal, the grow america act, the additional 100-plus-billion dollars to build our infrastructure is fully paid for by keeping the gasoline and diesel tax at the level it is today and going after the hidden profits of united states corporations that have skipped out on their responsibility to this country. they are hiding their profits overseas. we need to go after those profits and say you owe it to america. bring that money back and pay your just taxes. this is how it's paid for.

how much? $120 billion over six years. enough to get the job done. american corporations won't be allowed to run away from their responsibility to their country. they'll pay their fair share here in america. no more tax dodgers overseas, folks. so, where are we? the question for the congress of the united states is, are we going to go with what we have today? just a little bit more. just keeping up with inflation. is that good enough for america to be number one one? snow no. it's not. an we do better without burden ing the truckers and the commuters? we can, if we are willing to stop up to the american corporations, the big and powerful to say pay your fair share. the fair share is 14%, which is

less than one half of the corporate tax rate. let's see what happens. house of representatives, the men and women that you have elected are going to make some decisions, i'll make a decision about speaker, that will get taken care of. we'll make decisions about a few other things. but the infrastructure nature of this nation is fundamental to economic growth. i hope we make the right decision. i hope we make the right decision to grow this economy, make it america and give you the roads, the transit systems, the ports, the airports that you need and america needs. with that, mr. speaker, i yield back my time. the speaker pro tempore: the gentleman yields back the balance of his time. under the speaker's announced policy of january 6, 2015, the

gentleman from georgia, mr. collins, is recognized for 60 minutes as the designee of the majority leader. mr. collins: i appreciate the opportunity to be here this evening. it is a good time to be back here on the floor after coming back from a week. i'm always very pletioned to go see home and be a part of folks that get outside this beltway and get up and go to work and do the things that families do and communities do and do so with a sense of purpose and work. and i think tonight we are going to bring to light and talk about some of the great folks in our american pharmacists and the what they carry on every day. we are going to be joined by several of my good colleagues. we are going to be talking and have people come in and out.

and i hope the words will encourage and inspire those who care for our constituents. the first celebration of national pharmaceutical. in 2004, arm can pharmacists month brought it to the health care system. on october 1, we celebrated the pharmacist appreciation day and participated in the third annual tweetathon. this year from 1,285 and i want to share. can you give the flu shot through the drive-thru. we ensure medication. we save lives. we filled insulin after she was refused by the pharmacist. what does that man have in common?

i wanted to become a pharmacist. doctors rotated in and out. ever year, the association, the academy encourages and advocates and this year's theme is live your live. we will come back. live your why. it is incredible to read the stories from pharmacists. one of the most active and committed student pharmacist chapters in the nation. we can be leaders and have im pakistan on patients. this is going to do truly remarkable things. but it won't happen unless congress acts. we must level the playing field so pharmacists can not only compete. all they are asking for is a chance and we need to step up and we are going to share. and i start out with

representative and glad that you are here. and i yield time to you. >> mr. speaker, i rise today in support of pharmacies across the country, and the independent community pharmacies who operate in a tough business climate who provide patients with veept, affordable and personal care. in my home state, 72 of our 99 counties are considered medley underserved and of these 27 are served by only one pharmacy. a large number of these citizens in these areas rely on the farm as sis for life-saving drugs and treatments. the implementation of policy to address the rising cost of drugs

have led pharmacists at a disadvantage. often unable to cover the costs, community pharmacies are closing their doors at an alarming rate. this leaves them without access to the patient services they provide. to that end, i'm most happy to co-sponsor h.r. 592 to ensure pharmacists are recognized as providers under medicare part b so my constituents can have access instead of traveling local distances to seek out care. i'm proud to work with mr. collins as well as my colleagues across the aisle such as representative loebsack, to lower cost of drugs and promote fair competition and choice, which will ultimately benefit patients. i will continue i will continue to work to pass legislation to increase the

transparency of drug payment rates under medicare part d, and tricare, while ensuring that fair, exetsive market for generic drugs. finally, i wish to highlight the work of hardic drug stores, the second oldest family-owned independent drug store company in america, which has locations throughout my district, including my hometown of dubuque, iowa. they operate in three states, employing 437 people. i believe we should be enacting policies that allow these kinds of local pharmacies to thrive instead of shutting down. my hope is that through the continued hard work of their dedicated employees and the implementation of better policies at the federal level, these family businesses will continue to serve patients in and around my district for many years to come. thank you, mr. speaker, and i yield back to mr. collins. mr. collins: thank you. i think what you recognize is

the struggles that are going on right now. and what i found while speaking with a member tonight from one of our midwestern districts, on the floor, as we were voting earlier, i started explaining what was going on in our pharmacy, our independent pharmacies. and this member did not know. they had not had a chance to interact they did not know what was going on and the changes that were going on. you being here tonight helps highlight. that as we ked kate -- as we educate members thrks an inequity in our health care system that needs to be fixed. many things are talked about in our time up here, many times we talk about not being able to work together. this is an issue that draws us together, mr. loebsack, and i have worked through two congresses now on this issue. we're going to work on more together and it's my honor to yield some time to you to ex pounleds on this. because we've been working on this a while. it's good to have you here tonight. mr. lobiondo: thanks, it is great to be -- mr. loebsack: thanks. it is great to be here i know you have a lot of things going on your side of the aisle, it's a testament to your commitment that you have a number of colleagues here tonight to speak to this issue to speak to the importance of independent and community pharmacists.

it's really, really important for america, that we talk about this. and as mr. collins said, and mr. carter, i appreciate your invitation as well, it's really important that we speak to how important these folks are for our communities, for health care, for their patients, and, mr. blum, thank you for being here tonight as well. he represents the district that borders me to the north and he mentioned harding pharmacy. they have a pharmacy in iowa city, and took a little bit of time out of my schedule a couple of years ago to visit there and to hear the problems that they have when it comes to all kinds of issues. you know, today, or this month, of course, is american pharmacist month. it's a month during which we recognize the important role that pharmacies play in our communities. pharmacists are in fact frontline health care providers. and they're counselors for many parents who consistently depend on their training and expertise to stay informed, to stay healthy and to stay out of the hospital. they also play an incredibly important role in strengthening

the economies of the areas they serve. particularly in rural counties like so many of those that i represent, of the 24 counties i have. it's also crucial that these pharmacies have a level playing field, as was already mentioned by mr. blum. when trying to run a successful business in a challenging and complex environment, like most small business owners, community pharmacists face many challenges to compete. and negotiate on a day to day basis, with largentities on their business transactions. i have personally visited, as i've said, many of these pharmacies in my district. i've learned firsthand how they often struggle to compete. one problem i've heard, for example, from many pharmacists is, is that the reimbursement system, i'm sure we're going to hear more from folks about that tonight. for generic drugs, is largely unregulated and it's in fact a mystery to many folks. generic prescription drugs account for the vast majority of drugs dispensed d so it's critical for pharmacists'

bottom line that their reimbursement is transparent. however, pharmacists are reimbursed for generics via the maximum allowable cost or m.a.c., lists created by pharmacy benefits managers, p.b.m.'s, the drug plan middleman, something we've heard so much about. but the methodology used to create these lists is not disclosed. it's a secret. it shouldn't be a secret. it should be open. we need to have transparency on this front. also the lists aren't updated on a regular basis, resulting in pharmacists often being reimbursed below what it cost them to actually acquire the drugs. that makes no sense whatsoever. so, to address the problem i partnered with mr. collins to introduce h.r. 244, the m.a.c. transparency act, and we have a lot of folks on board on this, it's a bipartisan bill, at a time when, as mr. collins said, there's not a lot of bipartisanship in this body at the moment. and basically what this bill would do is it would ensure that federal health plan reimbursements to pharmacies

keep pace with generic drug prices, which can skyrocket overnight, as we know. i'm not going to go into great detail at the moment we've got time to talk about this a little bit more, there are other things we can talk about tonight. i just want to say a few things at the outset. just thank you again, mr. collins, and mr. carter, for setting this particular time aside so we can really educate our colleagues as much as anything about the problems facing independent community pharmacists. thank you so much and yield back. mr. collins: my colleague, i do appreciate that. that's exactly the issue here. is education. and people can look in on this, they can hear what we're talking about, they can see this education problem and this is found in every district. it's almost like veterans. there's no member of congress that doesn't have veterans issues. because it comes from -- every one of our districts has independent pharmacists. as one told me just the other day, he said if the condition doesn't change, they'll be gone in a year and a half. and when we think about this i've had even in my area county governments who believe that they can cut their health care

costs by going and taking the pharmacies and putting them with a p.b.m. and centralizing it for county employees. and they said that they would save x amount of dollars. and when i called my county commissioner and asked them, i said, you save this amount of money, but i said, if you realize, if you take county employees out of the system, government operating -- this is one of my -- side of the aisle, i said, you take government and put this in control, you're going to put pharmacies out of business. i said, how much do you save when they have to lay off employees they shutter their businesses, and you lose sales tax, property tax, and the peripheral income that comes with that? we've got to address -- that's why we're here tonight. this education process is important. when you come up through the legislative ranks, whether it's here in congress or the state house, where i started, you meet folks who you learn to have a great deal of respect for. especially from the places that they come. and what they have done in the past. buddy carter, congressman from the southeast coast line of georgia, is one of those who

actually is a pharmacist. i think one of the things i want to emphasize tonight, and some people may be saying, why are you bashing pharmacists? we're not bashing pharmacists. pharmacists are great. no matter where they work, it's the system that they're trapped in, that is broken. that is hurting the individuals who need that care. and so, tonight it's going to be a great perspective from one in the profession who understands these firsthand, from owning those pharmacies, but also dispensing and taking care of patients. with that i recognize my gentleman friends from georgia, mr. carter, for his comments. mr. carter: thank you, representative collins. and thank you for hosting this tonight. this is certainly a very important subject. very important to me, personally, yes. but it's more important to our health care system. mr. speaker, for over 2,000 years the practice of pharmacy has existed to help people with their ailments. today the most common pharmacy position is that of the community pharmacist.

community pharmacists are the front lines of medication. instructing and counseling on the proper use and as verse effect of medically prescribed drugs. however, over the past decade, there have been several issues that have threatened the role of community pharmacists. being a community pharmacist myself, i know these issues all too well. i believe that there are three main issues that we can address in congress that will allow the community pharmacists to continue to fill the invaluable role of counseling americans on the proper use and dangers of prescription medications. first of all, m.a.c. tranparency. m.a.c. pricing transparency. you know, when i became a member of the united states congress, and i got involved in government, i jokingly said that if i could learn 10% of all the acronyms in the federal government, i think i will have been a success. and then i got to thinkin about it and i feel a little

silly now because there are a lot of acronyms in pharmacy as well. one of those is m.a.c. maximum allowable st. another is p.b.m. pharmacy benefits manager. now, let's talk about m.a.c. pricing transparency. this is a bill that's bng offered, and this is a situation that needs to be taken care of. needs toe addressed. perhapsne of the most pressing, if not the most pressing, issues facing community pharmacists right now. m.a.c. is a price list. the maximum allowable cost is a price list that lists the upper limit or the maximum amount that an insurance plan will pay for a generic drug. in other words, if you have a generic drug and it's on that m.a.c. list, they're going to tell you what the maximum allowable cost is. that maximum allowable cost may $10. now, if you can buy it for $9, more power to you. but if you have to buy it for

$11, you're only going to get paid $10. that's whthey call it the maximum allowable cost. each insurance plan sets the maximum allowle cost for the plan. some states require them to followa certain policy, if you will, a certain procedure when they set those plans. those prices. most stes don't. and a lot of states that don, the insurance companies can set it wherever they want to. whatever they want to set it at. they may choose a drug that's only available in a certain area for a certain pri that -- for instance, if i'm in southeast georgia, i may not be able to get that drug at that price that they set it at because they used the price that's available in the northeast. and it's not available to us in the southeast. that's why we've got to have transparency. that's why we've got to have maximum allowable cost transparency. p.b.m.'s are supposed to ensure

that the cost of the drugs do not rise to unaffordable price levels. which is supposed to allow continued access to meications to americans and maintain low costs for employers who provide coverage for those employees. and that's very important. they are supposed to set those plans' that their recipients can get those medications. therein lies the problems. a couple of problems. one is what i just explained. that it's not always available at the price that they set. a second is that sometimes the price goes up. and we know that the prices of generics have been going up significantly and rapidly. and when that happens, sometimes the insurance companies, the p.b.m.'s, are slow to raise their m.a.c. prices. which means that if i've got a m.a.c. price of $10, and overnight the price of that drug went up to $20, until the

insurance company raises the m.a.c. price, i'm still going to get paid $10. even though it's costing me $20 . that cannot be sustainable for community pharmacists. pharmacy -- community pharmacy is somewhat different from other health care providers in that we have a product, we actually have a product that we have to pay for. we have that product. now, granted, doctors' offices have injectables they have to pay for and so and so and we understand that. but in community pharmacy, we actually have that product on our shelf and we've got to pay for it. regardless of how much we get paid for it. the wholesaler doesn't say, how much did you get paid -- did you pay for it, that's how much we'll pay you. that's not how it works. now, some of you may think, well, you can make up that $10, can't you? and charge the parent? no, you can't do that --

patient? no, they can't do that. if they have a co-pay, that's what they pay. i can't charge them to make up for that difference. that's not allowed. now, that's one of the things that's leading to the detriment of the community pharmacy. but perhaps an even more important point there is what happens with the patient. because keep in mind that ultimately what we're talking about here, when we talk about keeping community pharmacies open, when we're talking about making certain that this provider is available, we're talking about the patients. we're talking about the patients and patient care. if i'm not able to pay for that medication because i'm not getting reimbursed enough, that patient's not going to get the medication. and that's going to lead to even more medical costs. that's why this is so vitally important. in the end, what it comes to is patient care. what's the problem?

what's the problem with p.b.m.'s, with the pharmacy benefits managers? first of all, there's no transparency. there's no transparency in the contracts with the p.b.m.'s. or example, for example, a nonprofit hired a p.b.m. to help their costs for their 12,000 employees and families. is p.b.m. they would slice 673,000 from the annual medication spending. just three months into the contract, meridian was to balloon by $1.3. this p.b. many insisted that it was saving meridian money. it was not. after some investigation, meridian discovered this p.b.m.

was making gross profits to multiple times the amount. ridian was charged $93. 2 on ant buy on thics while they charged this to get the prescription spread. that is $5 $62. and there is the spread. difference between what the p.b. m charged the company and the difference in what they actually paid for. that is the spread that they work on. the amount that p.b.m.'s to customers can be significantly more than what it actually costs for them to fill the prescription. you know, p.b.m.'s don't always update their price list in a

reasonable amount of time and this hurts farm as sis and it hurts patients. there has been evidence to suggest that some wait until four to six months to update their reimbursement rates. there has been evidence of that. i have experienced that while i was still working, 10 months ago, before i entered the congress before i became a member of congress, i experienced this, i experienced where a product would go up in costs, yet the p.b.m. would not adjust their price, their costs. and we would have months, literally months where we were getting paid less than what we were having to pay for the drug. obviously, that is not sustainable. that business model doesn't work for anyone, regardless of who it is. is leads pharmacists getting

reimbursed. they can't sustain unless they know how much it costs. you are asking a business owner to operate with no understanding of revenue. no one in the country can you operate a business like this. we need as much as transparency are ke sure p.b.h.m. created to do. the act would provide much needed transparency to the operations of p.b.m.'s and provide a better understanding that their insurance coverage and the true drug costs. this is a very important piece of legislation. another issue that is very important and extremely important to pharmacist is provider status. mr. speaker, i graduated from pharmacy school in 1980. have a bachelor of pharmacy

degree. the pharmacists are graduating with a four-year professional degree that comes after a bachelor's degree. in most cases they have at least six and most, eight years of education. their clinical expertise is so impress i have. it has changed so much. we filled prescriptions to where now the pharmacist is a vital member of the health care team. mr. collins asked about someone getting a flu shot in the drive-thru and we have seen that. ut pharmacists are administering vaccines. how does that help in obviously our rate improves and keep in mind in south georgia where i represent, rural health care is

a concern. we quite often say in two georgias, there are is north georgia and the rest of georgia. access to health care is very important to georgia, particularly in the rural area of south georgia, where you find that pharmacists are some of the most accessible health care professionals out there. if it were not for the pharmacists, many would not get the vaccination. it is important we have provider status. the u.s. health care system is coming into a system that provides care to americans. this new structure of care will provide care that allows constant collaboration to provide the highest level of care. the mascrort of americans that rely on health care are the elderly. under part b of medicare,

pharmacists are excluded of providers under medicare part b. this is something that is going to have to change. regardless of how you might feel about the affordable care act. regardless of how you might feel what's our state of health care here in america now, one thing is for certain, we are going to have to utilize all disciplines in health care to improve our system. e are going to have to utilize nurses, physicians assist ants and make use of all of those. make no mistake about it. doctors remain the quarterback and are the captains of the team. we have to have them. but these services that have been provided in the old model where doctors did everything and the other health care professionals didn't

participate, in order for health care to sustain. we've got to utilize these. my wife is a physical therapist. physical therapists who are graduating are so clinically-on the parted and they can do so much more. and that's something that we have toe do. that's why it is vitally important that we have provider status for pharmacists. physicians, physicians assistant, clinical social workers, certified mid-wives, all of those are rurmable and covered under medicare part bmp, but pharmacists are not and pharmacists need to be included. they provide a health care plan for the treatment of the patient. however, i never experienced a patient without being prescribed mid occasions.

it's a vital part of it. if we don't give them the medication, the whole process fails. why does the patient go to the doctor and spend this time being diagnosed and this doctor use his expertise if they are not going to get the medication? we refer to it as a three-legged stool, you have the physician, the pharmacist and the patient. all of them have to work together to make the system work. if we really want to provide a health care system, pharmacists should be included ol medicare. congressman guthrie has introduced legislation. provide a include and true integrated health care team for patients. finally the third thing that we need to do and the congress can

do. some health plans, particularly medicare plans have selected certain plans to be the plan's preferred provider. we must have any willing provider legislation rather than allow insurance plans to pick and choose a preferred pharmacy. i have a lot of experience with. i have been practicing for over 34 years now. i have had patients who have been with me that long. they are part of my family. i have provided services to them and they have come into my store and provided generation of services to their parents and grandparents and now to them and grandchildren. the first of the year, they come to me some of them in tears and tell me i have to change pharmacies, but i don't want to. but this is the only one i can use.

some say, they can pay for the medications and submit the receipts. or they go to our prefer pharmacy. that's not a choice. that's not a choice at all. other plans will tell you, ok, you can use this pharmacy outside of our network. the co-pay is going to be $24. if you use our co-pay, it lib $5. if you have 10 prescription, you are going to pay $450 as opoiced to $50. that's not something that is going to lead patients. they don't want to change. having choice makes a difference. these relationships that patients have with their providers, their health care providers are very, very important. so, my colleague from virginia, mr. griffin, has offered

legislation to remedy this problem. the ensuring access act to 2015 would allow them to keep their farm asist if they agree to the prescription drug plan and we will be able to provide a free market system for prescription drug plans that will lower costs while provide comfort to americans. this is win-win. before you go saying, you want to force people to have to do this. no, i'm not there. you will not meet a free market person than me. we want the ability to compete. that's all we are asking to do, to participate in the free market. if the insurance company if the p.b.m. sets the reimbursement and i see that's the reimbursement they are going to pay me, if i'm willing to accept

it, i should be willing to participate. that's all we're saying. give us the opportunity if we are a willing provider to provide it. select networks are hurting us, but more importantly they are hurting the patients. the patient going to the pharmacy, where their parents went, now they are having to go and travel long distances particularly in south georgia to get to the farm as si that is a select pharmacy, the select provider. and a lot of times they do without. then what happens? medical costs rise and we don't see it here. that is a problem. so those three things, mr. speaker, are three things that are important to community pharmacy. i want to thank my colleague, from georgia, mr. collins for bringing this up. and let you know i have been

honored to serve as a farm asist. but most importantly, i want to make sure you understand this is about the patients. if community farm as cyst don't survive -- pharmacies, that is going to mean this health care suffers and i yield back. mr. collins: i appreciate my friend from georgia and the passion of what we are doing. we sent a letter to c.m.s. to ensure part d co-sponsors report prices. that was led by a good champion austin scott and i yield to him now. mr. scott: this is certainly a bipartisan issue and gets to the heart of some of the challenges in our country right now. and i rise in support of our nation's community pharmacies

which play a community role. they operate in underserved areas like the ones i represent in rural georgia and a doctor may be many miles away, doctors ive advice on drugs and many people see their pharmacist much more than their doctor and there is a relationship between these patients and the physician. their community pillars and contribute greatly to the economies. crucial that they have a level playing field when trying to run a successful business. i was a an insurance broker and i thought i might tell a personal story about a client who shortly after their contract was issued, a gentleman's child got sick and they needed a prescription filled. and they went to the local

big-box pharmacy and they wouldn't fill it for him even when i as the agent, without the card, they would not fill the gentleman's prescription. the local community farm asist was the one -- pharmacist filled the prescription. when the person got the prescription card, they could no longer use that community pharmacist and only one they needed. so it's extremely important that we keep those local community pharmacists where they're able to run a successful business and stay in business. and during the august district work period, i stopped by another drug store, a small drug store, been there many, many years, and generations of people have continued to rely

on them for their services. and while i was there, i watched one of our senior citizens, a lovely lady came in, owner called her by name, they caught up on family and friends and what was going on in life and she had some questions about the medications. and let me tell you, that pharmacist knew the answer to every single one and he knew her history with those medications. and was able to answer those questions that she asked and she left there with a smile on her face, knowing that she knew what she needed to take when she needed to take it and what she needed to take it with. as i stop at these local community pharmacists, like the ones i visited in august, i continue to hear concerns from them about, you know, what's happening in the pricing structure, and that if the price on a drug goes up, the insurance company has the ability and takes several

months to change the rate when the price goes up, but if the price comes down, as happens in free markets sometimes, they immediately reduce the price that they reimburse to the pharmacist. there should be no excuse for the difference in the time frame in which the reimbursement occurs. if it can be done when the price is changing to the down side, it can certainly be done in the same time limit when the price is changing to the up side. a lot of things that we've seen lately in pharmacy, we saw where a venture capitalist purchases a drug and raised the price of that drug several thousand fold overnight. that's been helping -- happening in local -- and local community pharmacists have expressed concerns with this issue for many years. it's happened with tablets that have been around for decades and decades have gone from eight cents a piece to $8 a piece. - apiece to $8 apiece.

how is this happening? and who's going to help us fix this if not for the ability to get the information from the local community pharmacist? they're the ones that care the most and they're the ones that are willing to help resolve the challenges with the higher drug costs in this country. is it one would ask, how that in many cases our local pharmacists are kept from being able to participate in the networks? well, in many cases the networks that are blocking out the local community pharmacists are actually owned by the big box pharmacists -- pharmacies. now, if you want to talk about a conflict of interest, that's about as conflicted as it gets. when your big box pharmacists own the network that actually can determine who you can get your drugs from and they box out their own competition. quite honestly i think it would

be a wonderful issue for the federal trade commission to get involved in and to bring competition back into that area. one of the things that i think would help is h.r. 793, the insurance seniors access to local pharmacies of act of 2015. i want to thank my colleagues that are here that are also co-sponsors for it. this bill allows community pharmacies that are located in medically underserved areas or areas that have health professional shortages the ability to participate in medicare part d, in the preferred pharmacy networks, so long as they're willing to accept the contract terms and conditions that other in-network providers operate under. this is reasonable. this is patient choice. this keeps the small business owner out there. and let me ask you to make no mistake about it. this is big business versus small business. one of the other things that i want to talk about is m.a.c. the maximum allowable cost.

pharmacists are often reimbursed for generics about -- by this m.a.c. list. you've heard buddy carter talk about this earlier. he certain linos more about it than i do -- certainly knows more about it than i do. nobody knows how they create this list. as patients we have a right to determine how the costs are derived for the drugs that we're going to take. it's not -- understand this. it's not a manufacturers' cost -- a manufacturer's cost. it's not a manufacturer's cost. it's a maximum allowable cost, and when the lists are updated, certainly it should be done on a timely -- in a timely manner. i'm happy to have co-sponsored the bill and hope to see that bipartisan bill passed. with, that mr. collins, i'd like to yield whatever -- with that, mr. collins, i'd like to yield whatever time i have back to you. thank you for taking the lead on this issue. our local community pharmacists are extremely important to our

health care system and there is a way to create a scenario under which the patients have more choice and that requires keeping that local community pharmacist in business. mr. collins: i don't disagree with you. i thank you for being here. you've been a great champion of this cause as well. i think the interesting thing here, and i want to repeat it, basically what we're going back to is simple fixes. we're not asking for one to be preferred over another. we're not saying what the p.b.m.'s want, they want to prefer and run you into their network, control you. most people don't realize that a lot of our community pharmacists have to buy from the p.b.m.'s who operate other big box stores who then in term audit them and can fine them if they don't follow the plan exactly. these are the kind of crazy things that -- go right ahead. >> they get to audit their competitors. now, in what other scenario in the world could you say it's a

free market when, when your competitor, who is the big box multibillion-dollar operation, gets to audit their small business competitor? mr. collins: it is baffling. that's why h.r. 244 simply says, seven days. you got seven days to update the list. number one. and number two, it says patients will not be forced by b.m.'s to use a p.b.m.-owned pharmacy. an obviously conflict of interest -- an obvious conflict of -- conflict of interest. p.b.m. pharmacies may charge 83% more than community pharmacies. tell me about what you're hearing out there. mr. loebsack: you know, first of all, i want to thank mr. carter, you know, it's testimonials like his that i've been hearing for the last nine years, since i've been in congress. since i first went to an independent community pharmacist. and you spoke with such great passion. you're not alone. as you know. every single person like you in my district can tell me the

same things that you've told me. and that's why i'm on these bills. that's why i'm talking tonight about these issues. i don't have the firsthand experience that you have as a pharmacist. the closest i ever got to a pharmacy other than picking up my prescription drugs, before i got into congress, was when i was 16 and 17 years old, i was a delivery boy for greenville pharmacy in sioux city, iowa. which by the way still exists. since 1969. actually longer ago than that. it was established. but i would deliver prescription drugs to folks. especially to the elderly. who couldn't get out of their home, who couldn't get to the pharmacy. that's what this is about, as you said. it's about making sure ultimately, and as a member of congress, my job is to make sure that folks have access to affordable, quality health care. and that's where pharmacists play such an important role. whether it's with medication, therapy, management or just simply conducting -- consulting on an informal basis with someone who comes in and has a

lot of different prescriptions and is confused by what to take and when to take them. you folks really do such a wonderful job and that's thank service, if we lost that service -- and that service, if we lost that service because of unfair business practices, because of being squeezed by the big guys, and it doesn't make any sense at all for that to happen, then patients would suffer in the end. you know, that's why i support both of these pieces of legislation too, these have been mentioned around, 244, again, to make sure that everyone understands what that's about, it is a measure that will increase transparency of generic drug payment rates and medicare part d, in the federal employees health benefits program, which serves a lot of folks, as we know, millions of folks, and in the tricare pharmacy programs. by requiring those p.b.m.'s, one, to provide pricing updates at least once every seven days. that doesn't seem like a lot to ask to me, and i'm sure it doesn't seem like a lot to ask for you. disclose the sources, number

two, disclose the sources used to update that m.a.c. list. and to notify pharmacies of any changes in individual drug prices before these prices can be used as a basis of reimbursement. this is complete commonsense. that's why there are republicans and democrats alike on this bill. and i hope we can move this bill forward. in iowa, the state legislature did passing is not quite this comprehensive, butting is similar to this. because -- but something similar to this. because in iowa folks understand what these p.b.m.'s are doing and what those independent community pharmacists are up against. the second piece of legislation that was already referenced, again, a bipartisan piece of legislation. it's got 218 co-sponsors. if memory serves me. that's exactly the number we need, if everybody votes, to pass a piece of legislation in this body. we could get it done. if we brought it to the floor. we could get it done. maybe we ought to do it this -- sorry, i don't mean to create too many anxieties there. but nonetheless, we got to get this thing done and it is about

making sure that our pharmacists are able to continue to deliver the kind of quality health care. look, whatever we decide at the federal level, when it comes to utilizing pharmacists to their full potential, this legislation does stipulate that nothing will override state scope of practice laws as well, because i know that a lot of folks in other professions have concerns about that. that farm siferts are going to go fu -- pharmacists are going to go too far. they're not going to. if states have laws in place, this legislation will not override that. but it's about making sure, as mr. carter said, and as mr. collins would agree, and others who have been so active on these issues would agree, it's about making sure that folks get the quality care that they need and if we close down these pharmacies and these rural areas, 95% of the folks in iowa are within five miles of an independent community pharmacist. if they close down those pharmacies, those folks in my district, who depend upon those pharmacies and those pharmacists are going to suffer

and that's unacceptable to me. thanks again for giving me the time to speak on this. mr. collins: you've hit it right. there are so many times we get to talking policy and big picture up here. and at the bottom line, what we do up here, and when i was in the state legislature, could you see it because you were a little bit closer. states are starting to pick up this mantle, as you just said in iowa and other states. but it goes back to that feeling of what i call security. now, pharmacists, as i said just a few minutes ago, the pharmacist is not the issue. the pharmacist is someone who helps. someone who helps in the curing process. they're part of that. i don't have anyone who watch this to say, why are you bashing pharmacists? we're not bashing pharmacists. what we are taking shots at and what we are trying to find solutions for is an abusive practice that has been set up in the name of saving money at the expense of the patient. that's unacceptable. it's time we have a hearing up here on those kind of abuses.

i call for that. i call for the bills to be brought to the floor. let's do those kind of things. we've got 26 co-sponsors and growing daily on h.r. 244. they're understanding the issue. as we go into this thing, one of the things that i talked about earlier and i said i was going to come back to it, was live your life. i want everybody to have a choice. if you like going to the big box and getting your bananas, your shotgun shells and your aspirin at the same place, go for it. that's great, i love it. but if you want to go to there and then go by and see your pharmacist who opens up had, that american dream, wanted to bring -- he sells other things, at my pharmacy i can get a scoop of ice cream. i can sil sit there and talk and see -- i can sit there and talk and see people and see life. that's what it's about. it's not about forcing us in. that's one of the problems on our side. we've had about health care in general. the government is not -- that's not the place. and this is an area where we've

got a thumb sort of on the scale and we have to stop that. i think this is what does that. your help has been tremendous in that regard. congressman carter, one of the things we see in georgia, and i know we've seen it in iowa, in short, you have a story, i hear these, i've got stories i'm probably going to share later, just where this has affected patients. several of my pharmacists talked about how they've had customers that have been coming to them for years and then get a disease that they can't keep the medicine because it's too expensive. do you have examples like that? where this kind of legislation would help? mr. carter: there's no question about it. as i said earlier, i'm a free market guy. all i want to do is compete. and i want to compete on a level playing field. let me compete. you know, when i first entered pharmacy, before p.b.m.'s became so vogue and became such a big part of this, it was pretty easy in the sense of being in business in pharmacy. because all you had to do was be nice to be the -- be nice to

the people. it was about customer service. it was about taking care of the patient. and that's what we're talking about. taking care of the patient. i told you earlier, i've had generations of families that trade with me. grandparents, parents. mr. collins: i want to jump in on this. one of the things you said there, how many -- if you have a story, we'll talk about it, like i've had, where, my own family member, had an issue, and we were discussing medscation. i knew the doctor, i could -- medication. i knew my doctor, i could call, but my first call was to my pharmacist. i knew i could get him, i knew he would answer. at the time, my parents didn't buy their drugs from him. but yet he picked up the phone, he heard my complaint. is that sort of what you see and what you have seen as well? . mr. carter: i have a community pharmacist for 45 years and business for myself for 28 years. i live near where my pharmacy is

and less than five miles. i was mayor of that community for nine years. for nine years. represent them now in congress. and i have gotten calls in the middle of the night and what is interesting and what has been very rewarding for me, when i ran for office and i would be knocking on doors and i would introduce myself, i know you. you helped my mother when she was in hospice care and got her medication. that makes you feel good. mr. collins: when you get into this about people and politics and drug stores -- these are the people, it's not about politics, it's about people. t's people, it's policy. it's folks in all of america.

mr. lobiondo: there is a reason for that. i realize you went from being a pharmacist to being a congressman. we might question your transaction and you are finding out about that. but nonetheless, every single time i go to a pharmacist, they care about their patients. again, i have so many stories that i could take forever for me to recount all the stories over the last nine years. i have 24 counties. i have a lot of local pharmacist. nd they are the most respected folks in the community. they are right up there with the clergy. that tells you something about their profession and about how folks depend upon them. they are the folks that get called when they are worried about their prescription. they are the folks that can be reached most easily.

but pharmacists are right there at the ready. mr. collins: and what we are talking about here tonight and if you are following, we can talk bills and regulations, but what is best in the health care arena. and you did a great job talking about the doctor and all the different agencies coming together. but the bottom line -- i'll never forget growing up, the story for me, when you got to the pharmacist, you were getting better. i got to the doctor's office and got my shot, just give me some medicine. it was some tasting-bad stuff. but i remember going in and would take time and they would care. in my district, you can go in and look at the community pharmacist that was on the square. a lot of them had lunch counters

and they sold cards. do not want to see through consolidation and corporate work that is a system that has a fingerprint on the scale that government has allowed this to happen to start taking away the centerpieces of american squares. when you start taking away the squares in a community, big or small, when you start doing that and we are part of the problem, it's time to start educating people. as anllins: first of all, american taxpayer, you can imagine me being in business and having what we have called taxation without participation. here we have medicare part d plans paid for and supplemented through the government that i

pay through taxes through. but my business is not allowed to participate. i'm paying my taxes and doing what i'm supposed to do. it's being used for a plan that excludes my business. how fair is that? i'm not asking for anything special. all i'm asking for is an even playing field. another thing i want to mention is that i have intentionally not mentioned the names of p.b.m.'s. and there are some good p.b.m.'s and not the company that i have the problem with as much as the process and the model. that's important to understand. we are talking about the model here. but i will tell you this. there have been numerous instances where companies think they are going to be saving money and the p.b.m.'s have misled them.

these are some of the most profitable businesses around. mr. collins: you may have heard -- i agree with you there are great p. pf b.m.'s out there. but the other thing that bothers me and i have heard from my pharmacists and we have talked about this, is my pharmacists, my community pharmacists are scared to say something. they are scared to talk about what is actually going on because they are scared their contract will get canceled or get another audit. you can't audit me and i'm going to say this, that's wrong. anybody who wants to say that, i don't ups that. when you have pharmacist its who are trying to run independent businesses and scared to talk about their vendors to work a workable plan, what are we doing

here? it should be busy. mr. lobiondo: it does nt serve any of us. if their voices cannot be heard, it stifles competition and that's not good for any of us. mr. collins: when things change and we can't give input. that's just a problem. we are coming up on our time of closing. any last comments? mr. lobiondo: thanks for inviting me -- mr. loebsack: i have learned something tonight and i appreciate your comments and i want to touch about the city square. that is so important in in our rural districts. kind of hard to explain that to our more urban colleagues but we have to do the best we can.

but a pharmacy is so absolutely critical to the economy of a small community. it is necessary to serve the population but it's important for the economy. we have a pharmacy in iowa, it's off the square a little bit, but it is such an important institution in its own right. every christmas, they have wonderful christmas decorations. people come to depend upon them to do the things they depend on them, not just the pharmacy. if they were to go under, i'm not sure they would survive and their tradition would be hurt and it would be a disaster for our local communities for those pharmacies to close down. i'm going to fight with you and do it together holding hands across the aisle which doesn't

get done around here but thanks again for organizing this. mr. collins: congressman carter. mr. carter: i want to thank you representative collins and my collins for participating. this has been a great exercise. and i want to ask you. one of my proudest possessions is the plaque that the baseball teams give you every year whenever you sponsor a team. i have a wall that is filled -- and you know, patients come in. i played ball and that was the team. the carter's pharmacy team. how many pb mmp's have you seen sponsoring? folks, we are talking about something that is essential to our communities. and this is a dire situation. if this is not fixed soon, you are going to see a whole

profession of community pharmacies going by the wayside. this is a matter of survival. we aren't asking for a government handout but to be able to compete in a free market and fair market on a level playing field. ultimately, the loser here is going to be the patient. if we do away and allow this to happen and community pharmacies go away the ones who are going to suffer are the patient. i thank you for this. a profession that i chose years ago when i was in high school after i realized i was haven't going to be an athlete, i decided on a profession and i did and i could not be any prouder than the profession i chose, the profession of pharmacy. mr. collins: i thank my olleagues and that's all we're

asking. independent pharmacists are saying, let us have an even playing field. we'll play with the big boys. let us have our why. and when we do that, our benefits to our communities. with that, i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. for what purpose does the gentleman from georgia seek recognition? mr. collins: i move that we do now adjourn. the speaker pro tempore: the question is on the motion to adjourn. those in favor say aye. those opposed, no. the ayes have it. the motion is adopted.

on the republican debt ceiling legislation this week. chairmans and means if he is was asked willing to run speaker of the house. he said he will make a decision about whether to run by friday. congressman jason chaffetz is dropped out of the rates -- race, and speaker boehner says he will announce new dates for leadership elections on wednesday. we will have a lot more about the house republican leadership elections on our c-span networks. about a half-hour ago, paul ryan spoke with reporters after

meeting with the republican caucus. cumbersome and ryan: tonight i shared with -- congressman ryan: tonight i shared with my colleagues what will be needed for a speaker to be successful. i made recommendations to what i feel is necessary, and i asked my colleagues to hear back from them by the end of the week. first, we need to move from being an opposition party to a proposition party. because we think the nation is on the wrong path, we have the duty to show the right one. our next speaker has to be a visionary one. second, we need to update our house rules so that everyone can be a more effective representative. this is, after all, the people's house. we need to do this is a team. -- as a team. we need to ensure that we do not experience constant leadership

challenges. third, we as a conference should unify now and not after a divisive speaker election. and the last point is personal. i cannot and will not give up my family time. i may not be on the road as often as previous speakers, but i have alleged to try to make up for it with more time communicating our vision, our message. members is, ifd you can agree to these requests, and if i can truly be a unifying figure, then i will gladly serve. unifying, that will be fine as well. i will be happy to stay where i am at the ways and means committee. here is how i see it -- it is our duty to serve the people the way they deserve to be served. it is our duty to make the tough

decisions this country needs to get our nation back on track. the challenges we face today are too difficult and demanding to turn our backs and walk away. global terror, war in multiple fronts, a government drone out of-- a government grown out touch. flat wages. a skyrocketing debt. on these take challenges alone. now more than ever we must work together. all of us are representatives of .he people, all people we have been entrusted by them to lead. yet