Health Information Technology Promotion Act of 2006

Madam Speaker, I too would like to say it is a privilege to come to the floor of the House and be able to address the House on important matters of the day.

In my first term in the House, the 108th Congress, and my background is actually as a physician, and when I came to Congress in 2003, one of the things that you do with a doctor when you put them in Congress is put them on the Transportation Committee. So I had a very good session of Congress on the Transportation Committee. I was fortunate enough after my reelection in 2004 to be placed on the Energy and Commerce Committee on the Subcommittee on Health. So having had experience in Congress on both roads and now health, what I thought I would talk about tonight is the road to affordable health care.

Some of the things that I want to talk about tonight are the overall affordability of health care and where we are in this country and where we are going. I want to talk about the public versus the private systems in this country. We obviously need to talk about the uninsured and some of the programs to help with the uninsured, federally qualified health centers, association health plans and health savings accounts.

You almost can't talk about health care in this country without talking about liability reform, and, indeed, we do need to touch on that, and the sustainable growth rate, patient access for Medicare patients, how physicians are reimbursed under the Medicare system, an item that is becoming of critical importance if we want to keep some of our best doctors providing care for some of our most complex and challenging patients.

Information technology has been one of the buzzwords up here ever since I started my time in Congress, and, indeed, we need to talk about that. Preparedness, whether it be from terrorism, whether it be from natural disaster, or whether it be from an outside source like the worldwide flu pandemic that hit this country in 1918, we need to be prepared for that should it happen.

We need to talk a little bit about the number of State mandates that are on insurance policies that tend to drive the cost of health insurance up and thereby reduce the overall affordability of health care.

There are some interesting things that are being done in some of the States as they approach some of the difficulties they had in providing health care to their citizens. I would like to particularly talk about Governor Mitt Romney's plan up in Massachusetts that provides for personal responsibility in health care.

Finally, if there is time, we will talk a little bit about the reauthorization of trauma centers in this country. We will talk a little bit about transparency, raise transparency for price cost and quality in our health care system and maybe just a little bit about long-term care, because that is one of the drivers that is going to vastly increase the cost of Medicare and Medicaid as more and more baby boomers retire.

Let me just remove this for a minute so it is not distracting to any other Member of the House who might happen to come by and look at it.

We talk about the current problem facing us. We spend a fair amount of money in this country on health care. We have a gross domestic product of upwards of $11 trillion, and we spend about 16 percent of that on health care; $1.4 trillion is spent on health care in this country. In fact, Medicare and Medicaid alone in our HHS appropriations bill, which we have yet to pass, that bill will probably be upwards of $660 billion just for Medicare and Medicaid.

Of course, we have the Indian health service, the veterans health service, Federal prisons also providing health care, so there is a significant chunk of this Nation's health care that is already borne by the Federal Government. The other approximately 50 percent is broken down to that care that

is just simply not compensated or not remunerated. You might call it charity care or just simply uncompensated care. Some of it is paid for out of pocket or self-pay, and certainly the lion's share is borne by the private insurance market in this country.

Well, between the public and the private sectors, how is the best way to get more health care coverage into the hands of more people? Should we just simply expand the public sector to the point where it encompasses all or nearly all of the health care expenditures in this country, a so-called Canadian system? I don't think so. Even the Canadian Supreme Court in 2004 and 2005 said that they had a problem with access in their country, and, in fact, access to a waiting list did not equate to access to care.

In the British national health service, some of the most expensive care in the world is in Great Britain. They have a two-tier system. They have their national health service, and then they have private care, and that private care in that country, the cost for that, has gone significantly up. The waiting time for someone who is over 80 years of age, that becomes really problematic. You put someone over 80 years of age on a waiting list for a procedure, a hip replacement, a heart bypass, and the likelihood of them being able to sustain themselves until they receive that service starts to go down. That's unfair as well.

Well, what about the private sector? I believe that we have the best health care system in the world in this country, largely because of contributions of the private sector.

We have more innovation in this country than almost anywhere else in the world. We have the ability to integrate new technologies rapidly into the treatment rooms, the operating rooms, into the health care system in general in this country.

Finally, because we have such a significant component that is borne by the private sector, we have willing sellers and willing buyers. The waiting list is not as big an issue, if an issue at all, in most parts of this country.

Some of the other things that we will talk about, as we talk about expanding the private sector, or at least maintaining the component of the private sector in this country, is the little bit of the history of what we called at one time ``medical savings accounts.'' We now refer to them as health savings accounts as they were expanded significantly under the Medicare Modernization Act of 2003.

But the old medical savings accounts had a lot of restrictions on them. There weren't many companies who stepped up and provided that type of an insurance product, and, as a consequence, you never saw the savings with medical savings accounts that, really, should have been there.

I will contrast that with health savings accounts now. You can go to your search engine, you can type in ``health savings account'' into Google, and you are offered a vast array of different companies and plans that sell, market on the Internet. With, in fact, the competitive power of the Internet, many of these plans, these high-deductible health savings account plans are priced well within reach, of, say, a young person just getting out of college.

Contrast that with the mid-1990s when a young person getting out of college who didn't have an employer-based health insurance, who just wanted to go buy an individual policy, I know, because I had experience with that in my own family, you just almost could not buy an individual health insurance policy for a single individual in the marketplace. No one was interested in selling that to you at any price. But now you can go on the Internet, and you can find a lot of products that are available.

The last time I looked, which, albeit it was a couple of months ago, but for a young person, 25 years, male, in the State of Texas, for a high-deductible plan, would range between $50 and $60. There were some that were even cheaper, but they were companies that I didn't recognize the name of, and I certainly wouldn't recommend that someone buy from someone they have never heard of before. But there were some reputable names, named insurance companies that had providers, provider lists that were more than adequate, that were for sale at a price that I would consider affordable for a young entrepreneur just perhaps starting their own business or leaving the protective fold of a group health plan from their employer.

How we keep the private sector involved and keep health care affordable is truly one of the challenges that we in this Congress, not just Republicans and not just Democrats, but both sides of the aisle, need to take on and meet head on.

Some of the downsides of going to a completel nationalized system is I am afraid we will lose a lot of the energy toward innovation. When you stop and think about it, we have had three Presidents in my lifetime who have espoused programs of a nationalized health insurance, President Truman, President Nixon and President Clinton most recently.

Under Truman, if they had gotten their way and nationalized health care, what if, what if we had stifled innovation with that type of maneuver? The antibiotics that we used today would be penicillin and tetracycline, those that were most commonly in use in the late 1940s and early 1950s.

Under the Nixon administration, what if they had gotten their way with the nationalized health insurance with, again, a chilling effect on innovation? We might be looking at treating psychiatric illness still with Thorazine rather than having the availability of the very potent antipsychotics and the selective serotonin reuptake inhibitors that we have now today. During the Clinton administration in the 1990s, there are just untold innovations that have happened.

Even in the last 15 years, there are innovations in the treatment of arthritis, innovations in the treatment of osteoporosis. In fact, if innovation had been stifled in 1992, osteoporosis would be treated today with estrogen replacement and pain medicines, as opposed to having the newer phosphonates or medicines like Fosamax and Actonel and Boniva that are available to us today.

When we look at the uninsured in this country, it is an election year, so we can certainly expect the number to go up. The most recent U.S. Census Bureau was 46 million people uninsured.

Interestingly enough, between the years 2004 and 2005, there were 1 million more people who had health insurance in 2005 than had it in 2004, and I suspect the reason for that was because of the expansion of health savings accounts.

But when someone is labeled uninsured, it means that for any portion of a year they lacked health insurance. It doesn't always mean, though, that they have no access to health care. Access to health care, I will tell you as someone who made a career of being a physician, access to health care is uniformly available. It may be expensive care, it may be care that is accessed far later in the course of the disease than anyone would recommend, but access to health care does not, or not having health insurance, does not equate to not having access to health care.

In fact, this Congress in the 1980s mandated that anyone arriving in an emergency room would have access to health care, whether or not they had the ability to pay for it. In fact, as a physician, I was required to respond to that patient within 30 minutes or a reasonable timeframe or face some rather significant civil money penalties. So lack of insurance does not equate to lacking access to health care.

We also have a system in this country, under the Federally qualified health center system, that provides health care and continuation of care in a medical home to between 15 and 17 million recipients. That is a significant number of people who lack health insurance but have access to a medical home and have access to care when they need it and, in fact, have continuity of care that in a lot of cases rivals that of any HMO out there.

There are some things we could do, I think, to strengthen the ability of federally qualified health centers to provide care when it is needed. I represent an area of north Texas, Denton County, Tarrant County. Fort Worth is the largest city in my district.

Last year when Hurricane Katrina hit the gulf coast, we had a number of persons who were displaced by Hurricane Katrina, who came to the Dallas-Fort Worth area, individuals who came needing medical services and not being able to wait the 6 to 8 years that is now

required to set up a federally qualified health center.

Indeed, last year, the Deficit Reduction Act, I tried to introduce amendments that would streamline the process of setting up a federally qualified health care that would make more of those facilities available to more patients so that they could have more services available to them.

Unfortunately, those amendments did not stand during the conference report. But there is still an opportunity to work on streamlining the startup procedures for federally qualified health centers. Indeed, in my district I am working on a couple of those even as we speak.

Another issue is having affordable products for companies to sell. You got 46 million uninsured. Don't think that Aetna Life and Casualty wouldn't look at that as potential market share if we would provide them the tools that they need to have an affordable policy available to individuals.

We will talk about this a little bit more in just a moment, but to give some relief for some of the mandates that are put on insurance companies, where they have to offer brow lifts and involved infertility treatments to every person who purchases their insurance when it may not be necessary, and, indeed, the cost of adding those benefits may be keeping insurance benefits from a greater segment of the population.

On the concept of health savings accounts, we did expand them significantly during the Medicare Modernization Act. There, in fact, is legislation out there this year. Eric Cantor, from Virginia, and myself have introduced legislation to expand and make a little bit more flexible the health savings account.

One of the things, in the interest of full disclosure, some employers will provide employees an amount of money to have each year to perhaps pay incidentals or eyeglasses or maybe even help pay for a higher deductible that is selected to offset some of the cost of the insurance premiums, these so-called use-it-or-lose-it funds that a company might provide a patient every year. But when you get toward the end of the year, and gosh, nobody wants to lose that money, they want to get the use of that money, it may be as much as $1,800 or $2,000, so we actually incent people to go out and spend more money on health care that perhaps they might not even need.

There was a big, full-page ad in the Dallas Morning News right before I left to come back up here about a doctor who provides refractive surgery, or LASIK, for someone's eyes, and if you have a use-it-or- lose-it policy at your work, look into buying yourself LASIK for Christmas this year, because you will lose that money if you don't spend it. Again, a kind of the wrong incentive and the wrong message to send to employees that yes, you have to spend at least $2,000 on health care every year or you are going to be penalized.

For people who are young and healthy who feel that they are bulletproof and they don't even need to buy insurance, making these HSA premiums payable with pre-tax dollars would be a powerful incentive to get these individuals to buy into the concept that they do need to insure themselves.

For low-income individuals, people who don't make enough money to even cover the relatively low cost of a Health Savings Account insurance premium, provide them with a pre-fundable tax credit or a voucher, if you will, to be able to buy that insurance, or perhaps at least buy down the cost of the insurance premium for someone who is not unemployed but doesn't make enough money to pay for health insurance.

What about someone who has got a chronic disease? A Health Savings Account may not be the best option for them. It might be, if we allowed employers to make a larger contribution, a larger or greater HSA contribution for someone with a chronic illness, say someone with diabetes, someone who is in remission from leukemia, a valuable employee that an employer wants to be able to keep on the payroll and keep on providing their insurance benefit and would welcome the opportunity to be able to buy one of these lower cost Health Savings Accounts and yet contribute a greater amount to that person's deductible.

Allowing flexibility to coordinate Health Savings Accounts with existing health coverage, like a flexible spending account or a health reimbursement account, and allowing early retirees to use HSA savings to pay for insurance coverage premiums until they are of an age that they can be covered on Medicare.

But probably the most powerful tool that we could employ is providing a pre-tax treatment of health care expenses incurred under HSA compatible plans. That has been something that has met with some resistance, but truly I think it is time to investigate that and take that up.

Association Health Plans. You hear it talked about. I have heard it talked about every year since I have been in Congress. Over 60 percent of all uninsured workers are employed by small businesses with fewer than 100 employees. But what if we were to give small business, give those small employers the ability to pool together, and if they are of a similar business model, say they are chambers of commerce, or say they are realtors, or say they are physicians or dentists offices, if they could pool together to be able to get the purchasing power of a larger entity, then they would be able to command more control in the insurance market and command a more cost-effective premium.

What if we allowed them to do this across State lines? That has been the difficulty in allowing, or for the Senate or the other body to allow the institution of Health Savings Accounts. They came very close this past year. I know they worked very hard on that over there.

Association Health Plans may not immediately bring down the number of uninsured like expanding Health Savings Accounts will, but allowing Association Health Plans would provide some measure of stability and affordability in insurance premiums that would allow small businesses more certainty in that market and would keep them from leaving the health insurance market for their employees.

Well, as promised, it is almost impossible to talk about the affordability of health care and not bring up the question of liability, medical liability reform. We have done that I don't know how many times on the House side.

Some states, my home State of Texas, has made great strides in improving the liability picture back home in the State of Texas. But these State-by-State solutions are in constant jeopardy by special interests who will reappear every legislative session to try to undo, for example, the good that they did in my home State of Texas.

When we passed H.R. 5, which was the Medical Liability Reform Act in this body in 2003, the Congressional Budget Office scored that as a savings of $15 billion over 5 years. I believe the amount really will turn out to be much greater than that because of the pernicious effect from a spending standpoint of defensive medicine. In fact, a study done out of Stanford, California, in 1996, in the Medicare population alone showed that the practice of defensive medicine cost about $30 billion a year in 1996 dollars to the Medicare system. So there would be a significant cost savings across the board in this country if we would be able to pass some type of meaningful liability reform. We are wasting money by not pushing for this on a national level.

What happens if we don't change? Well, several years ago when I was on the transportation committee we had a field hearing up in ANWR. On the way back we stopped in Nome, Alaska, for lunch and kind of had a Chamber of Commerce type lunch there in Nome, Alaska

Because it is unusual to have a congressional delegation come through Nome, Alaska, all of the people turned out for that, including all 19 members of the medical staff of the hospital there at Nome. They spoke to me with great concern saying, I hope you will be able to get that medical liability bill passed, because we can't afford the insurance premiums for an anesthesiologist at our hospital.

I said to the person sitting next to me, what kind of medicine do you practice, sir? He said I am an OB-GYN, just like you.

How do you practice OB-GYN without an anesthesiologist in your hospital? Forget an epidermal for pain relief during labor. What do you do if the patient requires a C-section?

He said, we get an airplane and take the patient to Anchorage.

Anchorage is an hour-and-a-half away, and that is if the weather is good. Nome, Alaska, as I understand it, has episodes of bad weather where aircraft can't take off. I fail to see, Madam Speaker, how we are furthering the cause of medical safety, patient safety, by allowing this system to continue.

In addition, the head of one of the residency programs in New York was speaking with me one night. I asked if the medical liability climate was affecting their ability to get OB-GYN residents into their program. It was related to me that evening that, well, Congressman, we are taking people into our program that we wouldn't have interviewed 5 years ago.

Wait a minute. These are our children's doctors they are educating today. How are we furthering the cause of patient safety, how are we enhancing patient safety by allowing that system to continue? The best and the brightest are not going to go into fields like OB-GYN or neurosurgery, so-called high-risk specialties that might expose them to a greater degree of liability peril.

Well, in Texas, we did do what I consider a very good thing as far as medical liability was concerned, and we did pass a so-called cap in Texas, a cap on non-economic damages.

It was a little different from the House-passed bill. The House- passed bill was a $250,000 cap on non-economic damages. In Texas we passed a bill that would cap $250,000 of non-economic damages for the doctor, another $250,000 for the hospital, and another $250,000 for a second hospital or nursing home, if one was involved. This bill required the passage of a constitutional amendment in Texas in 2003, and it did indeed pass, and now Texas is well into its third year of this medical liability reform.

What have been the results? Texas Medical Liability Trust, my old insurer of record when I left the practice of medicine in early 2003, the cost for premiums from Texas Medical Liability Trust, coupled with the rebates that had been given to doctors who were their customers over the last 3 years, have now totaled to over 20 percent. That is significant, because in the 2 years before I left the practice of medicine, my rates went up by 20 percent and 30 percent for those 2 years before I left the active clinical practice of medicine. So it is a significant change that has happened in Texas.

One of the major advantages has been what has happened with mid- sized, not-for-profit hospitals who were self-insuring for medical liability before. Many of these smaller hospitals have found millions of dollars that are now returned to them in medical liability premiums that are available for capital expansion, to hire more nurses, the kinds of things you want your mid-size, not-for-profit community hospital to be able to do.

We have some other options in our Committee on Energy and Commerce on our Health Subcommittee. We have talked about some of the other options. Arbitration, mediation, certainly if there could be an expansion of those to allow for an earlier settlement or even the concept of an early offer for someone who actually has been harmed.

One of the really unspoken but one of the significant downsides of our medical liability system is it takes on the average of almost 8 years for a patient who is truly harmed to receive any type of compensation. Then the amount of compensation they receive is strikingly reduced by legal fees and court costs and preparation costs and all of the things that go into that. So there is a very lengthy process that doesn't really help anyone as far as getting money to someone who is truly injured.

The concept of an early offer or even arbitration or mediation, we will have to make some adjustments to what is referred to as the National Practitioner Data Bank, and hopefully my committee will be able to take that up in the near future.

Let's shift gears for just a minute and talk a little bit about something that significantly affects patient access to physicians, and that is the proposed reductions in physician payment that are going to occur under the Medicare system, the so-called reductions because of the sustainable growth rate formula, something that I believe needs to be fixed and it needs to be fixed this year.

Under the sustainable growth rate formula, physicians' compensation is basically set. It is an attempt to limit the amount of expenditures of medical care under the Medicare system by controlling volume and intensity of services.

Other parts of medical care delivered under the Medicare system, the year-over-year rate is calculated based on the cost of input, a market basket type of update that is based on medical inflation. This rather graphically shows the results of the two different types of formulas.

Compare the reimbursement for the Medicare Advantage Plans, compare the reimbursement rates for hospitals or nursing homes with the reimbursement rate of physicians. This blue line here represents the year 2002. That was the first year that a cut was allowed to proceed under the sustainable growth rate formula. It was about 4.4 percent, what is euphemistically referred to as a ``negative update.''

The next 3 years, Congress came in at the last minute and said, we will give you a little bit of a bump up. As you can see, a little bit less than 2 percent for each of those years.

Last year, we held the SGR rate at a zero percent update. It didn't go up or down. Almost anywhere else in Washington, if you hold spending level for a year, you are accused of having cut benefits. But that is what we did for our physicians last year. And really part of that story is we didn't do it by January 1, we had to come back after the first of the year to provide that zero percent update. In reality, January 1 physicians got again a 4.4 percent negative update.

Yes, the administrator of the Center for Medicare and Medicaid Services did come in and say that as long as Congress does what it is supposed to do at the end of January, which we did, that CMS would come back and reimburse physicians for that amount of money to bring them up to that zero percent. Unfortunately, there are many private insurance companies out there that pay into Medicare; so doctors took a pay cut for other private insurance, which was never the intent of this Congress. It was never the intent of the administration of the Senate, but nevertheless, that is what we did.

The purple line here represents the proposed 5.1 percent negative update that is to go into effect if we do not affirmatively do something before January 1, and that is why I say it is incumbent upon us to do something, in fact, this month before we wrap things up on the 30th of September.

I would just like to make a couple more points about this graph. Cutting Medicare rates hurts all physicians and patients. Private health plans and other government programs follow Medicare's reimbursement trends. They look at Medicare's reimbursement rates, and they structure their plans to pay physicians the same, regardless of how much it costs the physician to provide the care. TRICARE, for example, reimburses at a rate that is 85 percent of Medicare. Many of the private plans will reimburse at rates that vary between 85 percent and 120 percent of Medicare. But, again, it was never the intention of this Congress to provide a break for private insurance with the SGR formula.

Setting up the silos for Medicare reimbursement is itself flawed. We have a silo for the Medicare Advantage programs, a funding silo for hospitals, for nursing homes, and physicians. With more procedures and more services being delivered outside of hospitals, the payments should be based on the highest quality and most cost-effective treatment setting. Elements of the sustainable growth rate formula originally were designed to control utilization by reducing physician fees. The primary drivers of utilization, however, are new, improved technologies, patients' increased awareness of treatment options, and the general shift from inpatient to outpatient care. Physicians control none of these factors.

And there is even one more factor over which physicians have no control,

and those are the mandates that this Congress puts on Medicare for types of medical care that have to be included. The Welcome to Medicare Physical, I personally think that is a good idea. I think you are going to pick up problems where you can more timely diagnose and treat those problems. But it costs money and that money comes out of the physicians' position of the SGR formula.

Again, in the Deficit Reduction Act, we passed a measure that would require every person on Medicare to have an EKG at age 65. That money comes from somewhere. It does not come out of the hospitals. It does not come out of the Medicare Advantage plans. It comes out of the physicians' part of the sustainable growth rate.

We also decided that everyone should have a screening for an abdominal aortic aneurism. It may or may not be worthwhile, but that money is going to be taken out of the physicians' portion of the SGR formula. And, again, physicians have no control over that utilization.

The legislation introduced right at the end of July, H.R. 5866, would put the focus to ensure that elderly patients have better access to the health care they need.

Four goals of this legislation: ensure that physicians receive a full and fair payment for services rendered; create quality performance measures that keep consumers informed; improve the quality improvement organizations' overall accountability and flexibility; and, finally, find reasonable methods, reasonable offsets for paying for these benefits.

For fixing the SGR, for title I of that bill, it ends the application of the sustainable growth rate formula January 1. So January 1, instead of a pay cut, SGR would go away. It substitutes for the sustainable growth rate formula a different formula. One that was derived by a group called MedPAC, the Medicare Payment Physicians Advisory Commission, called the Medicare economic index. And this shifts physician compensation so it will more closely mirror hospitals and Medicare Advantage plans. It bases updates and physicians' compensation on the market basket.

What does it cost to deliver the care and how much did that cost increase over the past year based on medical inflation? That is the Medicare economic index. We will use the Medicare economic index minus 1 percent, which will be an increase of about 2 percent for physicians for the year 2007. And it basically puts us back on a more market- sensitive system. What is health care inflation? What is it costing the hospitals, the Medicare Advantage plans, and the doctors to deliver the care and compensate them accordingly? Under the quality measures, in conjunction with physician specialty organizations, it creates a voluntary system of evidenced-based quality measures. It gives doctors feedback on their performance. As a physician, you are always wondering how you are doing; how do you compare to your peers; how do patients rate you. This is information that we are always seeking. It also allows patients to be selective. If a doctor elects not to voluntarily report, that information could be available to patients when they make their selection as to what physician they see.

There will be offsets in the bill. Currently, the offsets that are made are looking at the Medicare Stabilization Fund from the Medicare Modernization Act and eliminating the double payment for medical education costs in the Medicare Advantage plans.

The important thing here is it keeps the power in the health care community. It does not devolve that power to the Federal Government. And it is just a start. It is a start on the path of developing a product that will ultimately be satisfactory to all of the stakeholders.

A quote from the AMA news: ``We are encouraged by the introduction of this legislation that would replace the current flawed Medicare formula,'' from the AMA Chair, Dr. Cecil B. Wilson.

One of the things that is talked about a lot here on the House floor, and, in fact, we passed H.R. 4157 in July, which is the Health Information Technology Promotion Act, there is no question that health information technology holds a great deal of promise for being able to streamline the delivery of medical care to provide a method of continuity of care if something happens. With electronic medical records, those are then available online. And if something happens to a patient's original medical record, all is not lost. You can go to a safe, secure, sequestered Web site in order to retrieve that patient's medical data.

I will admit I came late to the table on health information technology and its promise to improve medical care in this country. My own attempts at electronic medical records, electronic prescribing seemed to increase the time involved with every patient interaction. And, of course, there is no additional compensation for that increased time with every patient interaction.

But last January, my committee, the Oversight an Investigations Subcommittee of Energy and Commerce, went to New Orleans and had an opportunity to visit Charity Hospital. And there in the basement in Charity Hospital we were still walking through water that was still in some places ankle deep, looking in the medical records room there in the basement of Charity Hospital. Here were rows and rows and rows of medical records that were absolutely ruined when the basement flooded and the water came in and now had black mold growing up and down the sides to some places where you couldn't even read those bright pastel numbers that were on the sides of medical records.

Clearly, Katrina showed us how vulnerable our medical data can be even in a venerable institution like Charity Hospital in New Orleans that you just assume is always going to be there and those records are always going to be there. Well, this time they weren't. And when some of those individuals came to Texas and came to north Texas, it made delivery of their medical care much more difficult.

The bill that we passed does provide for updating some standards, reporting on the American health information community, with a strategic plan for coordinating the implementation of health information technology.

Well, talking about Charity Hospital, talking about New Orleans, I mentioned that we were going to discuss preparedness. And we are just beyond the 1-year anniversary of Hurricane Katrina. We have to step back and ask what we have learned. While we watched that hurricane, my wife and I, coming up the Gulf of Mexico, it was almost like watching a train wreck in process. We were transfixed by the hourly reports of the progress of the hurricane. It looked like it was just going to hit the central city of New Orleans and just at the last minute took a little bit of a turn back to the east, and the central city of New Orleans was spared. And I think the headline in my paper was ``Bullet Dodged,'' or something to that effect. It was only later, not even that day but the next day, on Tuesday, when we realized how serious the situation had become because of the flooding caused by the breaches in the levees.

Back in my district, my home district in north Texas, we watched, of course, as people were taken into the Astrodome and then, of course, as the waters rose. And people who had not left the city of New Orleans had to be evacuated. Many of them were evacuated to Dallas, Texas, to Fort Worth, Texas, where my district office is in southern Fort Worth. A gymnasium on the same campus where my district office is was converted to a shelter for individuals who had been displaced. We set up 250 pallets that night. We had chicken dinners that were donated by a restaurant, waiting for displaced persons from Katrina when they arrived. Some very tragic stories from some of the individuals who arrived there over the next couple of days.

I got a call from my staff, and they asked me how soon can a woman who has had a C-section sleep on the floor? I said, why do you want to know this information? They said, well, we have three women here who just had C-sections, and we want to know if we can put them on pallets or if we have to find cots for them.

I said, I will be right there.

One of these individuals, her baby had been in intensive care. They were separated in the process of the evacuation. And it was only after several days with my staff spending every hour on the phone that we were finally able to reunite mother and baby. And just

this past week they had a 1-year anniversary there in Mississippi with mother and baby, celebrating the anniversary of not the child's birth, but the mother and baby getting back together after the hurricane was over.

The Dallas County Medical Society, on a holiday weekend, Labor Day weekend, the blast fax went out to probably 800 members of the Dallas County Medical Society. A quarter of them showed up in the parking lot of Reunion Arena to help with the medical care for people who had been evacuated from the Louisiana Gulf Coast. What a tremendous story of all of the individuals getting off the buses that evening. They had a triage desk set up. If someone had been off their meds and simply needed meds, there was a mobile pharmacy set up where they could be administered those medications.

And of all of the people who got off the buses that night, in the thousands, only about 200 required hospitalization as a result of having been in a shelter and off their medications for several days. The doctors that were there did a tremendous job of identifying who was sick and who was simply in need of a hot shower and a warm place to sleep and getting back on their medications.

One of the other great stories was there was a lot of fear with this many people crowded into a shelter, would there be an outbreak of transmissible illnesses like gastrointestinal illnesses, infectious diarrhea? They had hand sanitizers. You could not walk 10 feet without someone putting a bottle of hand sanitizer in your hand. People used them repeatedly throughout the day and night, and as a consequence, only a very limited number of people actually had any type of gastrointestinal illness. They were quickly sequestered in another facility, and as a consequence, a public health crisis was averted.

In follow-up, I have traveled to New Orleans twice in the past year, once in October at the request of one of the hospitals down there to try to get some help for their medical providers. And then in January, as I mentioned, our Oversight and Investigation Subcommittee went to New Orleans, and we had a hearing down there. It really was remarkable to see what the difference in preparedness between the Charity Hospital and the private hospitals, Tulane University Medical Center.

HCA hadn't planned necessarily for a hurricane, but they had some disaster plans in place. They had been rehearsed. They had been practiced. And as a consequence, when we were there in January, they were about ready to open their emergency room again. Charity Hospital still appeared to be light years away from being able to reopen.

So some of the lessons that came out of that trip down there were when you have disaster plans, when you have preparedness plans, it is not good enough to just have them and have them on the shelf. And I heard this from nursing homes, and I heard this from hospitals that, unfortunately, there were places that had purchased disaster plans but no one had looked at them. You have got to take them off the shelf, you have got to break the seal, you have got to break the shrink wrap that surrounds them, and you have got to practice them.

Our chairman of the House Government Reform Committee held a series of hearings on what happened in the aftermath of Hurricane Katrina. And for any House Member who hasn't read or at least looked at that publication that they put out as a result of those hearings, the title was ``Failure of Initiative.'' That is truly an outstanding work that Chairman Davis did, and I know every House Member got a copy of that and I would recommend that they look at that. Remember, this was a committee, a special select committee. It was bipartisan, though many people on the other side of the aisle chose not to participate. It wasn't an unelected, unaccountable commission like the 9/11 Commission. These were our House Members who were truly interested in what happened in the aftermath of Katrina and were very interested in getting it right.

As you think about Hurricane Katrina, as you think about 9/11 and some of the disasters that have befallen not just this country but the world, with the tsunami right after Christmas in 2004, the fact of the matter is we just can't afford to fail next time, whether it is a hurricane, whether it is a terrorist, or whether in fact it is a problem with a worldwide pandemic.

And I won't spend a lot of time on this, because I can talk about the avian flu for an hour in and of its own right, but just a couple of points. As of September 8, 2006, just last week, the World Health Organization had confirmed 244 human cases of avian flu with 143 deaths.

What is so remarkable about this illness is that it seems to be so lethal. That is an over-50 percent mortality rate for influenza. That is unbelievable to have that type of mortality rate.

During the summer months on a trip over to Iraq and Afghanistan, I was actually able to stop in Geneva for a few hours and talk to some of the folks at the World Health Organization. At that time, when I was there, there were coordinating efforts between 192 different countries. Dr. Michael Ryan, who is the director of the Strategic Health Operations Center, provides strategic support and global coordination to the World Health Organization, the Center for Disease Control, and our own Health and Human Services Administration. Dr. Ryan, I should point out, is on loan to the World Health Organization from the Centers for Disease Control. And the idea is that we won't reinvent a global CDC over there, but we will take the expertise of the CDC, apply it to the World Health Organization, and allow them a greater reach as far as monitoring and notifying.

The concept is to control the disease at its source, culling of infected avian populations, isolation of infected avian populations, or humans should they become infected, vaccination and antivirals for people who are exposed or infected. We need intelligence, we need verification, and we need assessment, and we need a response, all of which can act globally, because as this map shows, it is indeed a global issue.

This shows eight areas where the avian flu has occurred and areas where human cases have occurred. If you notice the time line, the arrows are pointing from east to west. And with the migratory flyways, it is possible that in wild birds and wild water fowl, the carriage of this disease could occur from the eastern hemisphere to the western hemisphere perhaps as early as this fall or winter. To date, it has not been detected in the western hemisphere. To date, there has not been an easy or facile transmission from human-to-human. Human-to-human transmission only occurs with great difficulty. The virus hasn't undergone that mutation that would allow for facile transmission from human to human.

But clearly, with a disease that is so widespread in the avian population and with a disease that has shown such a striking lethality rate, it is critical to keep the surveillance up and to make certain that other countries do what they are supposed to do in this regard. International transparency is absolutely key. A country keeping silent on a problem it is having with this illness is not only not acceptable, but it may be lethal to other areas in the world as well.

It is already a pandemic in birds but not in humans. The best way to prevent a pandemic is to control it in animals before effective human- to-human transmission occurs, meaning to minimize cross-species contact and make certain that in countries where avian populations are infected that there is the proper culling of avian populations, and that it is done safely without unduly exposing those people who are handling the infected birds.

Protecting North and South America from this global health threat, all of the outbreaks have been contained so far. Indonesia was a point of particular concern a few months ago where many people appeared to be infected in a cluster, but it does appear that those were all a direct result of either living with infected birds or close human-to-human proximity that allowed for that human-to-human transmission.

Clearly, we have got to prevent the spread to the United States and Central and South America. The disease at this point may know no boundaries because of its distribution in the avian population. And other countries, it is critical we have got to monitor the disease at the border.

I did also take a trip just up the street to Bethesda, Maryland to meet with Dr. Anthony Fauci to talk with him about a vaccine development. There are some remarkable things that are going on as far as vaccine development.

I guess one of the important aspects of bird flu is we are going to develop more capacity for delivering more vaccine for just the regular flu as a consequence for the preparedness that is happening with getting ready for the possibility of a worldwide pandemic.

This may not be the one. Avian flu may sputter out and never be the pandemic that everyone fears. But the fact remains that almost for every century that anyone has kept track, about three pandemics per hundred years do occur. We did indeed have three during the last century, and even a relatively mild pandemic of the Hong Kong flu still claimed 50,000 lives in this country. So it is a matter of no small importance.

Additionally, we have got to be certain that, just like the nursing home in Louisiana that left their disaster preparedness plan on the shelf with the shrink wrap still on it, we have got to be certain that we take those plans down and we talk to our local first responders, our local health departments. And I had such a roundtable just last week in my district, very well received by the folks at the health department, by the administrators in all three hospitals in one of my counties. I wish we had a little more participation of the medical staff, but we did have some and I did at least receive an invitation to talk at one of thei medical staff meetings.

But the key for us here in Congress is when faced with whether it be the avian flu, terrorist attack, another hurricane, we have got to be honest. No spin, no sugar-coating, no BS. And, above all, we have to communicate with our constituents and with our first responders back at home.

One other thing that I want to talk about as time runs short here is, and I mentioned this earlier, about a bill that is out there to reduce or restructure the number of mandates that are on health insurance. Again, Aetna Life and Casualty might look at 46 million uninsured individuals as potential market share if they only had a product that they could sell.

Now, in our Committee on Energy and Commerce we had a debate on a bill that would reduce significantly the number of State mandates on insurance policies in the individual market. This wasn't even discussed in the group health insurance market, but just the individual market. It was a pretty contentious debate and there wasn't a lot of agreement across both sides of the aisle, and that is unfortunate, because when the American people watch what this body does, they are really not interested in the tennis match or volleyball match that goes on from one side or the other. They want results. They want more affordable health care, health insurance. They want Aetna Life and Casualty to be able to look at that 46 million uninsured as a potential market share.

Well, what if we could get together across the aisle and discuss what is that basic package of benefits that we would like to see available in a health insurance policy, one that could be sold on the Internet from State to State. It seems like an almost impossible task, or at least it seemed almost impossible that night when we were debating this bill in the Energy and Commerce Committee. But the fact is we have already done that work. I say ``we.'' I wasn't here 30 or 40 years ago when the federally qualified health center statutes were first written. But in fact, in that statute in law is identified a basic package of benefits that has to be offered at every federally qualified health center.

Well, we have already agreed then in principle what that basic package of information is. Now, the information may be 30 or 40 years old, but perhaps we could sit down and decide which of those things we could eliminate because they are no longer necessary, which of those things we would have to add because we have learned some stuff since then, and then go to our private insurers and say, here is a basic package of benefits that, if you will abide by these rules and make certain people know what they are buying, that there is full disclosure about what is covered and what is not covered in these insurance policies, that you can then market this to the uninsured. And then give individuals who are unemployed a voucher or a pre-fundable tax credit to purchase that insurance. Or give that family that is of a low-wage earner, give them some additional health, buy down that premium.

These are the types of concepts that, really, the American people are anxious to see us work on, and I for one would really welcome the day that we could do that.

Just one last brief thing about the Medicare part D, the Medicare prescription drug program that actually started the first of this year. At the end of the enrollment period, well over 38 million people had prescription drug coverage under Medicare. This was the population, the Medicare population that was the largest population that didn't have access to a prescription drug plan if their employer or retiree insurance did not offer it.

This is a tremendous benefit. We will and do hear a lot of discussion about people who are caught in the so-called gap coverage. But remember, there are plans out there that if a person is willing to consider a generic compound, there are plenty of plans that cover in the gap; and in my home State of Texas, there was at least one insurance company that would cover both brand and generic in the gap.

So I would encourage people who have looked at the difficulty they are having with the so-called donut hole, when they re-up on their insurance plan, their prescription drug plan in November in that open enrollment period, look at one of those plans that will provide for coverage in the gap.

Madam Speaker, I yield back the balance of my time

Mr. Chairman, I yield myself 5 minutes.

I rise in strong support of the legislation and would submit my opening statement for the Record.

I would like to comment on some of the comments of my colleagues made earlier. Before I do that, let me just take a moment to thank Chairman Barton and Representative Nathan Deal and my own chairman, Chairman Bill Thomas, for their support and effort in the development of this bill. But instead of doing my opening statement, let me comment on some of the things that have been said to this point.

First of all, on the issue of privacy, this bill sets the groundwork to improve privacy by putting in place a study of State privacy laws and Federal privacy laws so we can see what is working, what is not working, how similar are the State laws, where might their differences inhibit the security of a nationwide system. In other words, it gives us the knowledge we need to upgrade our HIPAA system if, indeed, that is necessary. It may tell us that is not necessary. But it would be absolutely irresponsible to move ahead without the information that will be developed as a result of this legislation. HIPAA already provides absolute protection of our health information.

What we want to know is when you do what this bill envisions, that is, you create a nationwide interoperable health information system to put that in place and secure personal health data, are there changes you need to make in Federal law? Are there commonalities in State laws that need to be brought closer? Are there any changes, indeed, that need to be made to absolutely secure individual personal health data as we move to this system? That is the issue on privacy.

Secondly, this bill adopts a whole new coding system, the ICD-10 system. Under today's system, you cannot tell whether a hospital has made a great leap forward in quality because they are doing a better job or simply because they have changed an operative technique from an invasive operation to a noninvasive approach to that surgical procedure. So we have to know more about what we are doing so we can talk honestly to ourselves about quality, so we can upgrade quality, and so we can pay accurately. This bill does that.

This bill sets up an Office of Technology, and we need that office to assure that the public and private sectors work together to create an environment in which great companies in America compete to provide the best possible technology, all of which becomes interoperable.

So without a Federal office involved, without standards being set, we will not have that interoperable system that we know is going to be so important to improve the quality of our health care system.

Not only do we need to have standards; we need to accelerate dissemination because the power of health information technology is not in a single provider. It is in the system-wide impact of it. So this bill helps disseminate that technology in part through its grant provision. But, realistically, the government is not going to pay for this. The system is going to do it because it creates such system efficiencies that it pays the system back. However, in addition to grants we encourage the system to be able to dissiminate technology by allowing consortium to develop, by allowing a hospital in a small town to work with the big employers in that town, the big insurers in that town, to get together to get a good deal on technology or on several technologies so that technologies are appropriate to the providers but are interoperable.

So this not only deals with the development of standards, with the dissemination of technology, with building the knowledge base we need to ensure the privacy of personal health information. It moves to a more modern coding system, and it will deliver to us a dramatic revolutionary increase in the quality of health care available in America. It will not only reduce medical errors and eliminate adverse drug interactions, saving millions of dollars, reduce administrative costs by billions, but also allow us to do chronic disease management for our seniors, care management for the severely ill, and upgrade the quality of diagnosis and

treatment and return ourselves to a patient-centered affordable health care system.

So this is an important bill that sets the foundation for the future. And I am astounded at my colleagues on the other side of the aisle opposing it because it does not do things we are not yet prepared to do.

Today the House of Representatives has the opportunity to pass legislation that will lay the foundation for a new era in health care. Systemwide adoption of health information technology will dramatically improve the quality of care. It will reduce medical errors, reduce duplication and unnecessary care, and bring cutting edge information to the service of doctors as they diagnose and treat their patients. It will also eliminate many of the administrative inefficiencies that characterize the American health system and strengthen and protect the security and confidentiality of health information systems. In short it will fundamentally advance the practice of medicine and improve the quality of care all Americans will have access to.

Unfortunately, the adoption of health information technology has been frustratingly slow. Since the full potential of this technology can only be harnessed if it is widely disseminated amongst all types and sizes of providers, it is imperative to pass H.R. 4157 to speed the adoption and diffusion of health information technology.

This legislation is modest in scope. It lays the groundwork for fundamental change by removing the barriers to private sector adoption. It provides for a national framework for the development and widespread dissemination of interoperable health information technology by creating an office to coordinate the development of a national health information system. It promotes common-sense cooperation between doctors and hospitals and other providers by allowing entities to provide physicians and others with hardware, software, training or IT support services. It updates diagnosis coding systems for the digital age and provides an expedited process for ongoing updating of technology standards. It begins a process for creating greater commonality amongst state and federal security and confidentiality laws and regulations in order to better protect and strengthen the exchange and health information. Additionally, it provides grants for the adoption of health information technology to coordinate care among the uninsured and to implement technology in small physician practices. Finally, it includes studies and reports on the expansion of telehealth services in Medicare.

Health information technology touches every aspect of the health care system. It will enable us to provide disease management for all those with chronic illnesses, care management for those with severe, complex illnesses, and provide access to preventive and appropriate care for the uninsured. It will reduce medical errors, adverse drug interactions, and decisive support to improve the quality of diagnosing and treating patients.

The role technology can play in the systems of health care will be as revolutionary as the role technology has played in health care research and treatments. H.R. 4157 removes barriers to greater adoption of information technology in the health system so the long overdue potential of technology can be realized in health care.

Mr. Chairman, I reserve the balance of my time.

Mr. Chairman, I yield 2 minutes to the gentleman from Pennsylvania (Mr. English).

Mr. Chairman, I yield myself 40 seconds.

Mr. Chairman, my colleagues on the other side of the aisle are acting as if we had technology that, if we only had the money, we could implement. That just isn't so. Secretary Levitt and Dr. Brailer have led a phenomenal aggressive, strong effort and through their effort, working with the public and private sector, they have established standards for electronic health records and for E-prescribing.

But there are a lot more standards to be set. And in this bill, we do have a date certain, but it is way off in 2009. I think we will get there before then. But, as important, we put in this bill a very progressive, accelerated way of updating those standards, because this is going to be about continuous improvement.

My colleagues on the other side of the aisle that talk about minority health are absolutely right. Unless we get health information technology implanted and we move to chronic disease management and health care management, we cannot meet the needs of care our minority population need. That is why this bill is so important.

Mr. Chairman, yield 2 minutes to the gentleman from Missouri (Mr. Hulshof).

(Mr. HULSHOF asked and was given permission to revise and extend his remarks.)

Mr. Chairman, I ask how much time is remaining.

Mr. Chairman, I yield 1 minute to the gentleman from New Jersey (Mr. Ferguson).

Mr. Chairman, I yield 30 seconds to the gentleman from Pennsylvania (Mr. Murphy).

Mr. Chairman, I yield the balance of our time to the gentleman from Illinois (Mr. Kirk).

Mr. Chairman, I claim time in opposition to the amendment. I don't intend to oppose the amendment. I am just claiming the time.

Mr. Chairman, I think the gentleman's amendment points out why health information technology is so terribly important to making the next leap forward in quality that medical science has made available to us.

It will take a lot more teaching of patients. It will take a much different relationship between nurses and medical personnel and patients to make sure that they have the guidance and support they need to prevent their disease from getting worse or to follow a regimen that will prevent their chronic illness from compromising their lives.

So this issue of communication is going to be a bigger issue in the next round of the American health care system even than it is today.

But I would like to yield to the gentleman from Pennsylvania for some questions.

Mr. Chairman, we certainly are willing to accept the gentleman's amendment. It is a very thoughtful and important one.

Mr. Chairman, I yield back the balance of my time.

I rise to support this amendment.

I claim time in opposition.

I claim time to say we accept the amendment. It is a very thoughtful amendment and an important one, and we thank the gentleman from New York (Mr. Towns).

Mr. Chairman, I rise in opposition.

First of all, the gentleman from Illinois has brought a very thoughtful amendment to this bill. The information that he wants included in electronic health record is extremely important information, and I support your amendment.

Mr. Chairman, I rise in support of the amendment. I understand there are some technical adjustments that your staff and our staff talked about that we will work on.

With that understanding, I am pleased to support the gentleman's amendment.

Yes, I claim time in opposition to the amendment. Although I do not oppose the amendment, I would like to comment.

Mr. Chairman, I yield myself such time as I may consume.

I would like to comment on the amendment. Mr. Price has been a very active and fine mind as we developed this bill, and I welcome his amendment.

I do think we need to evaluate new methodologies and procedures very carefully; and as a physician, he brings to this issue a lot of information and a lot of concern about both advances and also problems that could develop.

I will say one of the strengths of the bill that has not been talked about on the floor here today is that it does move us to the ICD 10 system from the ICD 9 system, and that will give us a great deal more ability to look at quality, to judge quality, to pay for quality, to analyze actually what series of symptoms responded best to precisely what treatment approach.

But there are also shoals in every water, and I think your study is very appropriate. The ICD 10 system is now not only more glandular, but we also think it will help us to reduce fraud and abuse. But no matter how many positive things we think it will contribute, it is also wise to know and watch for and evaluate whether or not it is creating problems that we did not anticipate.

So I welcome this study, and I thank Mr. Price for his contribution.

Mr. Chairman, I yield back the balance of my time.

Mr. Chairman, I rise in strong support of this amendment. First of all, of all the systems in America that really need this kind of attention, it is our Medicaid system because they deal mostly with elderly and poor whose health has long been neglected.

So I know this is going to give us a lot of very good insight and information into how we can both improve the quality and reduce the cost of care in our Medicaid system, and I congratulate the gentlewoman and her cosponsors for bringing this before us today.

Miss McMORRIS. Mr. Chairman. I yield back the balance of my time.

Mr. Speaker, remember, adoption of HIPAA was a multi-year process, very controversial, very difficult, 50,000 comments just on the regulations.

My legislation explicitly does not change HIPAA.

The behavior described of hacking in and revealing what would be under HIPAA is a fine of $250,000 and 10 years in jail. So HIPAA is there. It protects our privacy.

What this bill does is to put in place a study to look at what has happened in the States, what has happened between State law and Federal law, to look and see if there are things that need to be done to create greater commonality amongst all these laws so that the nationwide interoperable health information system will protect health information to the current or a higher standard. So in the bill it has to be to a higher standard. But we maintain current law. There is absolute protection.

And, remember, this specific approach was rejected by Donna Shalala and President Clinton; so do not take this vote lightly, folks. What you are voting for is a radical change in a law that is terribly important to all of us and we maintain in this bill.

Mr. Speaker, I demand a recorded vote.

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 952 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentlewoman from California (Ms. Matsui), pending which I yield myself such time as I may consume. During consideration of this resolution, all time yielded is for the purpose of debate only.

(Mr. LINCOLN DIAZ-BALART of Florida asked and was given permission to revise and extend his remarks.)

Mr. Speaker, the rule provides 1 hour of general debate with 35 minutes equally divided and controlled by the chairman and ranking minority member of the Committee on Energy and Commerce and 25 minutes equally divided and controlled by the chairman and ranking minority member on the Committee on Ways and Means. The rule also provides one motion to recommit with or without instructions.

Mr. Speaker, the information age has greatly changed our economy by bringing about increased efficiencies in productivity. Virtually every sector of our economy benefits from the use of new information technologies.

Right here in Congress, for example, the use of technology has opened up access to the workings of our democracy like never before. Technology allows our constituents to quickly view the status of a bill or to look up our voting records.

Mr. Speaker, the health care industry has not fully embraced the advantages and benefits of information technology. According to a study by the RAND Corporation, only 15 percent of physicians and 20 percent of hospitals use computerized patient files.

Broad use of information technology in the health care system would certainly improve the quality and efficiency of health care delivery.

The use of health information technology is increasingly necessary to deliver the best care possible to individuals with chronic illnesses. The use of health care IT would also promote interoperability between providers and payers.

Efficiencies from coordinated development of health IT will accelerate and advance private and public efforts to improve quality, lower costs, reduce fraud and abuse, and promote the coordination of care. The synergy of these efficiencies will help achieve better health outcomes for patients.

The Health Information Technology Promotion Act, which we bring to the floor today, will improve the quality of care Americans receive through national adoption of electronic medical records and e- prescribing systems.

The legislation promotes the adoption and use of interoperable health information technology that prevents medical and prescription errors and costly duplicate tests, eliminates lost medical records, simplifies our administrative system, and improves medical care and the treatment of chronic illnesses.

The legislation we bring to the floor today provides grants for the use of health information technology to coordinate care among the uninsured and to implement technology in small physician practices. It also updates diagnostic coding, systems for the digital age, and provides for an expedited process to update standards.

Mr. Speaker, this legislation was introduced by Congresswoman Nancy Johnson, my dear friend, who is a true expert in the field of health care. It was reported out of the House Energy and Commerce Committee. We believe it is time that the health care industry moves to a digital future, and this legislation is an important step in seeing that to reality.

Mr. Speaker, I would like to thank Congresswoman Johnson and Chairman Barton and Chairman Thomas for

their leadership on this important issue. I urge my colleagues to support the rule that brings this legislation forth as well as the underlying legislation.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, Yeats wrote many wonderful, beautiful things. We in the Rules Committee deal with reality. The reality of the rule that we bring to the floor today in order to bring the underlying legislation on information technology for the health care industry brings forth and authorizes six amendments, six amendments to be debated by this House.

Our function is to listen, and we listened hour after hour after hour after hour, with great respect, in the Rules Committee to our colleagues who come forth with multiple ideas. We bring forth six amendments for the consideration of this entire body today. Of the six amendments, four are authored by Members of the opposition, of the Democrat Party; one is a bipartisan amendment, Republican and Democrat; and one is a Republican amendment. We think we are being fair, Mr. Speaker.

So we seek not to bring forth the beauty of Yeats, but in dealing with reality, in dealing with listening to hours of testimony from our colleagues, in authorizing four amendments of Democrats, one of a Republican, one of a bipartisan nature, we think we have done a fair job. And that is what we have authorized for consideration, for debate by this House in the rule that brings forward this very important legislation that we will be hearing about, and we will be hearing about as the authors of the legislation explain it in detail.

I am very proud to be a supporter of the legislation. It is important that information technology reach as much of the health care industry, patients, as possible so that mistakes are avoided, and so that access to the great advances of technology are made available to the largest number of people. There are important issues that this legislation is going to be bringing forth and dealing with and that this debate will entail.

Now, obviously in order for debate to begin, we have to pass the rule which sets the terms of the debate. We are proud of those terms of debate, the extraordinarily fair nature of the terms of that debate. As I have said, Mr. Speaker, four amendments made in order are Democrat amendments, one is a Republican amendment, one is a bipartisan amendment.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield myself such time as I may consume.

I thank all of my colleagues who have participated in this very interesting debate today. Much has been made by opponents of the legislation of arguments with regard to privacy protections. I think it is relevant and should be pointed out that the very significant and extensive privacy protections contained in the Health Insurance Portability and Accountability Act of 1996 are not reduced in any way by this legislation that we bring forth to the floor today.

In fact, the American Psychiatric Association, the American Psychological Association, the National Association of Social Workers, the National Mental Health Association have said in a letter to the Energy and Commerce Committee, ``The Energy and Commerce language ensures that the current protections in the Health Insurance Portability and Accountability Act of 1996 are maintained, and we wish to commend the approach to privacy protections that the Energy and Commerce Committee proposes to take.''

I mean, it is relevant to point this out because much has been said that would seem or could be interpreted to contradict what I have just read from the American Psychiatric Association, the American Psychological Association, the National Association of Social Workers, the National Mental Health Association, very responsible entities that look out for the interests of many citizens who receive health care.

So, Mr. Speaker, urging the support of the underlying legislation, I also urge all of my colleagues to support this rule, which is very fair, makes more than twice as many amendments by Democrats than by Republicans in order. It is precisely in our interest to go the extra mile for fairness.

Mr. Speaker, I yield back the balance of my time, and I move the previous question on the resolution.

Mr. Speaker, I thank my good friend, the gentleman from Florida, for yielding me time; and I yield myself such time as I may consume.

(Ms. MATSUI asked and was given permission to revise and extend her remarks.)

Mr. Speaker, every Member of Congress recognizes the importance of health information technology. It holds the potential to save lives by reducing medical errors, and it can make our health care system more efficient by providing better care while keeping costs down.

In short, we could revolutionize the way our health care is delivered. What exactly is the potential? Physicians could have access to every relevant part of a patient's medical history at the precise moment a life-or-death decision needs to be made.

It is the tens of thousands of lives saved because of fewer medical errors. It means the newest ``Physicians Desks Reference'' and the most cutting-edge medical research on a hand-held device that a doctor can have at the patient's bedside.

This is not pie-in-the-sky ambition. Some health care leaders have already begun to adopt these ideas with great success. In the year 2000, the Veterans Administration implemented the most advanced electronic medical records system in the United States.

A recent article in Business Week noted that ``while studies show that 3 to 8 percent of the Nation's prescriptions are filed erroneously, the VA's prescription accuracy rate is greater than 99.99 percent, a level most hospitals only dream about.''

It should not be surprising that while many patients lost their paper medical records in the terrible aftermath of Hurricane Katrina, veterans did not. Veterans living in New Orleans were able to access their medical records at other VA hospitals because of health information technology.

Another example comes from my hometown of Sacramento. The UC Davis Medical Center has a world-renowned telemedicine program which connects patients in 80 rural areas across California to an immense amount of specialty care in Sacramento.

Let me tell you the story of Levi, a child who lives on a ranch in a nine-person town 60 miles north of Sacramento. After accidentally suffering third-degree burns on his leg, his parents took him to the closest hospital. Because of UC Davis's telemedicine program, Levi was treated by one of the few pediatric burn specialists in this country remotely from Sacramento.

Information technology could make this amazing program even better. Widespread adoption of this technology would enhance this expert advice by allowing the rural doctor to send Levi's medical history to the specialists at UC Davis instantly.

UC Davis has begun to implement electronic medical records, but many of these outlying areas cannot afford this technology without seed money.

That is the goal of establishing a national health information infrastructure. But we know such a comprehensive program isn't cheap. It could cost individual hospitals several million dollars and individual physicians $20,000 or $30,000 apiece.

So the issue needs more than Federal guidelines. It needs Federal financial support, seed money in a sense. Unfortunately, the bill we will debate today falls far short. It provides only $40 million in Federal grants. In a $1.3 trillion health care system, this does not even scratch the service.

In fact, the nonpartisan Congressional Budget Office, CBO, says the bill, as written, will do almost nothing to encourage health information technology. According to their analysis, it will not significantly influence the rate at which health information technology is adopted, nor will it ensure better quality technology.

Democrats have proposed a more effective proposal, backed by Federal seed money, just like the bipartisan Senate bill does. We would also add new privacy laws to strengthen patient protections. This would prepare us for the health information age.

It would require patients to give their consent before their health information could be shared with other people. It also requires data encryption to protect these health information networks from hackers.

It sides with patients by making sure that everyone, every individual and every health entity, complies with privacy protections.

Unfortunately, late last night the Rules Committee denied the House the opportunity to debate the Democratic alternative on the floor. As a result, I will be urging my colleagues to defeat the previous question and defeat this rule.

Mr. Speaker, information technology will bring our Nation's health care system tremendous benefits, but the devil is often in the details. This technology will not install itself. It will spread only with the right kind of Federal leadership. So, I urge my colleagues to support the Democratic substitute and support the responsible approach to national health information technology.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield 2 minutes to my good friend, the gentlewoman from California (Mrs. Capps).

Mr. Speaker, I yield 3 minutes to the gentlewoman from California, my good friend (Ms. Eshoo).

Mr. Speaker, I yield 4\1/2\ minutes to my good friend the gentleman from Massachusetts (Mr. Markey).

Mr. Speaker, I yield 4 minutes to my good friend, the gentleman from Rhode Island (Mr. Kennedy).

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I am asking Members to vote ``no'' on the previous question so I can amend this rule and allow the House to consider the Dingell-Rangel substitute. This substitute was offered in the Rules Committee last night, but was blocked on a straight party-line vote.

Mr. Speaker, I ask unanimous consent to print the text of the amendment and extraneous materials immediately prior to the vote on the previous question.

Mr. Speaker, I believe the Dingell-Rangel substitute offers Members a far better choice than the underlying bill.

This substitute is based on the bipartisan bill that was introduced by Senators Frist, Enzi, Kennedy and Clinton and passed unanimously by the Senate last November. This substitute also contains important privacy protections necessary in this new electronic world.

The Democratic substitute requires the Federal Government to take a leading role in the adoption of standards for technology and adopting technology that will permit providers and others to communicate to each other electronically. This substitute will provide $257 million in grants and loans for providers and regional collaboratives to buy and implement health information technology.

This substitute also provides privacy protections beyond those in current law to ensure that patients' health information is secure. It requires that all individuals and entities with access to personal health information must comply with privacy protections to maintain patient confidentiality. The substitute also requires data encryption to prevent security breaches and the notification of patients in case of a security breach. Finally, it allows patients to seek redress when their privacy is breached.

I want Members to be aware that a ``no'' vote will not stop us from considering H.R. 4157. A ``no'' vote will simply allow the Dingell- Rangel substitute to be considered by this House by an up-or-down vote.

Vote ``no'' on the previous question so we can consider this important and responsible substitute.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, on that I demand the yeas and nays.

Mr. Chairman, I yield myself such time as I may consume.

Mr. Chairman, I am pleased that the House today is going to consider H.R. 4157, the Health Information Technology Promotion Act of 2006. This legislation should help move our health care system into the modern era and the modern information age.

We all remember a time when e-mail was a dream and getting the legislative text from the House of Representatives Web site was impossible because it simply did not exist. As information systems have moved into the digital age, Congress and most of the private sector have embraced it. We have found that we could get information much more efficiently and quickly at much less cost.

The health care system, for whatever reason, has not done that. For all of its medical genius and astonishing technology in terms of surgery and orthopedics and diagnosis, American health care is still stuck back in the 19th century, with a paper record system that is inefficient, wasteful, error-prone and occasionally dangerous. The legislation before us today should change that.

With H.R. 4157, records that have been stuffed in a file cabinet and illegible prescriptions that nobody can read scrawled on pieces of paper will finally give way to digital medical records, electronic prescribing, and efficient coordination of care. Sick patients will get better and everybody should save money.

The bill before us sets out a framework for endorsing core interoperability guidelines and mandates compliance for a Federal information system within 3 years of endorsement of such guidelines. Of vital importance are provisions contained in the legislation that create safe harbors to the Stark and Anti-kickback laws for the provision of health information technology and services to better coordinate care between hospitals and providers. These changes are long overdue.

Hospitals and other health care entities that have invested in systems that are tested and work well should be able to share their experience and purchasing power with physicians. Current laws have prevented these reasonable steps to better coordinate patient care by not allowing the sharing of health information technology systems.

Also, I would like to express support for the Secretary of Health and Human Services to look at the list of entities that we make eligible for this safe harbor and to expand upon it, specifically, to include independent clinical laboratories which carry a great deal of health data that should be shared electronically.

These safe harbors will allow for economical sharing of health information technology to better coordinate care, reduce medical error, and improve patient outcomes.

Medical science in recent years has produced tremendous discoveries that have revolutionized how we treat disease and care for patients. Unfortunately, the medical record information technologies needed to take advantage of these discoveries remain locked in an era of paper and filing cabinets. We can do better, and the legislation before us today will do better.

Mr. Chairman, I reserve the balance of my time.

Parliamentary inquiry, Mr. Chairman.

Mr. Chairman, how is time going to be rotated? Do we do all the Energy and Commerce time and then the Ways and Means time; or do we rotate in sequence?

Okay. Congresswoman Johnson says the Energy and Commerce Committee goes first.

Okay. That is what Congresswoman Johnson also says. I was not informed of that.

Mr. Chairman, I yield 3 minutes to a distinguished physician member of the Committee on Energy and Commerce, Dr. Murphy of Pennsylvania.

Mr. Chairman, I yield myself 30 seconds before I yield to Mr. Castle.

Under the current law, called HIPAA, we have very strict privacy protection guidelines. Those guidelines are currently under review. There have been over 50,000 comments filed with HHS for some proposed changes in those. Nothing in the Senate bill, that is a companion bill to this bill, deals with privacy.

Privacy is an important issue, but more important is that we get a health information system technology in place, and that is what this bill does.

Mr. Chairman, I yield 2 minutes to the former Governor of the First State, the great State of Delaware (Mr. Castle).

Mr. Chairman, I yield 2 minutes to another distinguished member of the Energy and Commerce Committee, who is also a medical physician, Dr. Burgess of Texas.

Mr. Chairman, I yield 2 minutes to the Vice Chairman of the Energy and Commerce Committee, the brightest bloom to come out of Laurel, Mississippi, Chip Pickering.

Mr. Chairman, I yield 2 minutes to a distinguished congressman from the Pelican State of Louisiana, who is a cardiovascular surgeon, Dr. Boustany.

Mr. Chairman, I yield 2 minutes to a member of the committee, the distinguished majority whip from the Show-Me State of Missouri, the Honorable Mr. Blunt.

Mr. Chairman, before I yield to Congressman Clay of Missouri, let me compliment Subcommittee Chairman Deal for his efforts on this bill. He cannot be here today because his mother is ill, but he worked very hard.

Mr. Chairman, I yield 1 minute to the distinguished congressman from Missouri (Mr. Clay).

Mr. Speaker, I rise in opposition to the motion to recommit.

Mr. Speaker, I want to compliment my good friends who have spoken on this motion to recommit. I know all three of the gentlemen, and they are fine fellows and fine public servants and believe passionately in what they speak of. If I were a doctor on this debate, I believe I would have to recommend they take a Valium and just calm down. We do not get this fixed if there is a problem.

Whatever the law is today on medical record privacy, the law is going to be tomorrow on medical record privacy. Nothing in this bill changes that. This is a health information technology bill. We are actually trying to get medical records in our country, the greatest Nation the world has ever known, to use technology that many other industries and many other groups have already incorporated into their daily business routine.

Now, there is an ongoing study at HHS on privacy. They have received over 50,000 public comments so far. This bill before us, if it becomes law, has an implementation period. There is going to be adequate time to come back, if we need to, with a specific medical technology privacy bill.

In past Congresses, Mr. Markey and I have been co-chairmen of the Privacy Caucus in the House, along with Senator Shelby and Senator Dodd in the Senate. I am as strong an advocate of protecting personal privacy as anybody in this body. I would say Mr. Markey and others share the passion just as strongly as I do.

The bill before us today is not a privacy bill. This motion to recommit is a privacy amendment. We should reject it and then move the underlying bill. And if and when we need to address medical privacy as a stand-alone issue, there will be adequate time and adequate resources devoted to that.

I yield to the gentleman from Rhode Island.

Mr. Speaker, reclaiming my time, they are covered under adequate laws, and HIPAA is the medical privacy law.

Please vote against the motion to recommit.

Mr. Speaker, I yield the balance of my time to the subcommittee chairman from the Ways and Means Committee, who has worked so tirelessly on this bill, Mrs. Johnson of Connecticut.

I know the rules. I'm supposed to be standing up. I apologize.

Mr. Speaker, I yield back the balance of my time.