Health Equity and Accountability Act of 2007

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 1368 and ask for its immediate consideration.

For the purpose of debate only, I yield the customary 30 minutes to my good friend, the ranking Republican of the Rules Committee, Representative Dreier.

All time yielded during consideration of the rule is for debate only. I yield myself such time as I may consume.

I also ask unanimous consent, Mr. Speaker, that all Members be given 5 legislative days within which to revise and extend their remarks on House Resolution 1368.

Mr. Speaker, as the Clerk just read, House Resolution 1368 provides that section 803 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 shall not apply during the remainder of the 110th Congress.

This resolution is needed today because of a procedural gimmick which was stuck into the Republican Medicare prescription drug bill in the dead of night shortly before the bill found its way to the floor back in 2003. The provision was a way for Republicans to get conservatives in their party to support an unpopular bill that may very well be the largest campaign donor payback program in the history of this institution. However, even this provision failed to prevent one of the most shameful nights in the history of this institution as arms were twisted and threats delivered into the wee hours of the morning to get the votes needed to pass this bill.

Under current law, when the Medicare trustees project in two consecutive trustee reports that general revenues will exceed 45 percent of Medicare spending within a 7-year window, an expedited process is triggered to reduce the percentage. This expedited process, however, bypasses regular order in the House, as well as the Rules Committee. Once the percentage of Medicare funding coming from general revenues reaches 45 percent, the President is required to send legislation to the House and Senate that will address the matter. That bill must then be introduced by the House majority and minority leaders and referred to the appropriate committees.

The process by which that bill, or any bill meeting the requirements of the trigger, moves through the committee process and is discharged to the floor includes a privileged motion. The privileged motion requires only one-fifth of the House, or just 87 Members, to second the motion and force a vote on that motion that would bring the bill itself to the floor for a vote. Under the trigger, if this small minority of the House is successful and the motion passes the House, the bill would come to the floor within 3 legislative days and can be debated with up to 5 hours of general debate and 10 hours of debate on amendments.

Adding to the unprecedented nature of this provision, amendments are given blanket waivers with the only requirement being certification by the

Budget Committee that the bill will eliminate excess Medicare spending from general revenues. Astonishingly, the trigger waives the rules of the House and blocks Members from raising points of orders against the bill for earmark, PAYGO, or any other violation of House rules. All that a Member needs to do to force a vote on discharging a bill is introduce a bill titled ``To Respond to a Medicare Funding Warning.'' As long as that bill meets the requirements of the Budget Committee, then anyone, Democrat or Republican, may seek to disrupt the proceedings of the House. Realize, if the House fails to pass this resolution today, it will leave itself vulnerable to chaos and extraordinary political gamesmanship.

We will lay the groundwork to effectively becoming the Senate, stalled and unable to act as a victim of its own rules and procedures. Every moment of every day here in session, under the guise of trying to fix Medicare, a Member could move to discharge a bill which includes provisions that have nothing to do with Medicare. The only way to avoid this chaos and potential shutdown of the House in the 110th Congress is for the House to pass this resolution today.

What is perhaps most troubling about this entire process, Mr. Speaker, is that Congress fixed the revenue problem in a more comprehensive manner last week when the House and Senate both voted to override the President's veto on the Medicare Improvements for Patients and Providers Act. In that bill, Democrats, in a bipartisan fashion, removed waste, fraud and abuse in the Medicare advantage plan without hurting seniors. Under our leadership, seniors continue to have access to their doctors and prescription drugs without having their premiums raised or coverage reduced.

Very occasionally, Mr. Speaker, many of us talk with different people in our constituency. Last week I had an opportunity to talk with a physician in this city named Stern. And Dr. Stern indicated to me that I should, among other things, fight real hard to have people understand how effective Medicare is and what a single payer plan could do for this Nation. We talked considerably about this, and I'm delighted that I had an opportunity to be edified by someone that is in this profession.

But because of this Medicare trigger provision, a provision which was not in the House or Senate bill and was slipped in the conference, I will repeat, slipped in the conference during the dead of night, and I was here, Pete Stark and David Dreier, all of us were here when this happened, forced to deal with the legacy of, in my opinion, the misguided former majority.

I urge my colleagues, Mr. Speaker, to do the right thing and support this resolution.

I reserve the balance of my time.

Mr. Speaker, I yield myself 30 seconds.

I want to say to my friend, the ranking member, everything debated in this House doesn't have to be a battle. Turning off this provision is the correct thing to do, and I will tell you why.

The perceived problem with Medicare funding has already been addressed. Let me repeat that. The perceived problem with Medicare funding has already been addressed. The recently enacted Medicare Improvements for Patients and Providers Act fixed the funding of Medicare to keep it below the 45 percent trigger.

Let me refresh your memory. On July 15, the House voted to override the President's veto of this important legislation. Every single member of the Rules Committee, Democrat and Republican, voted to override.

Mr. Speaker, I yield 2 minutes to the distinguished gentleman from New Jersey (Mr. Pallone), a member of the Energy and Commerce Committee and a champion of SCHIP, which required overriding twice a veto by the President.

Announcement By the Speaker Pro Tempore

Mr. Speaker, before I yield to the next speaker, I won't respond to the distinguished minority leader, but I would like to submit the statements of the AARP and the National Committee to Preserve Social Security and Medicare in support of this resolution.

National Committee To Preserve Social Security and

Medicare,

Washington, DC, July 24, 2008.

House of Representatives,

Washington, DC.

Dear Representative: On behalf of the millions of members

and supporters of the National Committee to Preserve Social

Security and Medicare, we strongly urge you to support H.

Res. 1368 when it comes to the House Floor. H. Res. 1368

would suspend section 803 of the Medicare Modernization Act

of 2003 (known as the Medicare ``trigger'') for the remainder

of the 110th Congress.

The Medicare ``trigger'' requires the Medicare Trustees to

include a finding in their annual report whenever they

project that general revenues will make up more than 45

percent of total Medicare funding within the first seven

years of the 75 year valuation period. This finding was made

in the two most recent annual reports, thus requiring the

President to submit legislation to Congress to bring the

federal contribution to Medicare down below the 45 percent

threshold. The legislation is subject to expedited procedures

designed to hasten its consideration. H. Res. 1368 would

suspend the Medicare ``trigger'' through the remainder of the

110th Congress.

The 45 percent threshold at which the ``trigger'' is set

was a completely arbitrary limit included in the Medicare

Modernization Act. There has never been a public debate on

whether it is appropriate to establish a cap on the federal

revenue contribution to the Medicare program at any level,

nor has any policy rationale been identified for selecting 45

percent as that federal contribution limit. The fact that

more than 45 percent of Medicare financing may come from

general revenues poses no more of a problem in itself than

the fact that 100 percent of the financing for defense,

veterans' benefits, education or most other federal programs

comes from general revenues. The problem facing Medicare is

the cost of health care, not how the cost is allocated

between revenue sources.

Limiting the federal government's contribution to the

Medicare program ignores Medicare's financing structure,

which was designed to rely on general revenues to finance

about 75 percent of Part B and Part D. This structure allows

the revenue raised by income taxes to shoulder a higher

portion of the responsibility for Medicare's funding, placing

the burden on a revenue source which is relatively

progressive and taxes all income.

If general revenue contributions are limited, the burden

would shift to beneficiaries, who are typically retirees on

fixed incomes or the disabled, generally the least able to

shoulder the burden of increased costs. In fact, about 70

percent of Medicare beneficiaries have incomes under $25,000

and 85 percent have incomes under $40,000. Nearly two-thirds

of older households have incomes under $20,000, and they are

already spending 30-50 percent of their incomes on health

care.

Arbitrarily cutting Medicare without getting at the root of

the continuing upward trend of health care costs is a

strategy for failure. It has real impacts on real people--

most of whom have nowhere else to go for coverage and limited

ability to pay higher medical costs, accounting for rising

senior bankruptcies.

Measuring Medicare's financial health solely by considering

the percentage of general revenues contributed to the program

produces a meaningless number, which will nonetheless be used

as a catalyst for policy decisions that could have a

devastating effect on the health care of seniors and people

with disabilities. For example, the 45 percent limit has been

triggered, in part, because more beneficiaries are being

treated in outpatient settings than in hospitals. While this

shift may disproportionately increase costs for Medicare Part

B, which accelerates the date at which the cap will be

reached, when compared with Part A, which is not counted in

the limit, it is generally considered a positive development

in health care.

A second major reason the cap was triggered is the Part D

prescription drug program. Although Part D is providing

needed drugs to millions of seniors, the cost of these drugs

is still rising much faster than general inflation. We

believe this is the result of the lack of a traditional

Medicare drug option, which the Medicare Modernization Act

specifically prohibited. In addition, the Act provided

billions of dollars in subsidies in order to entice private

insurance and drug companies into the Medicare program. While

passage last week of H.R. 6331 helped trim some of the most

egregious overpayments, billions in subsidies continue to

flow to private companies. Both the rising cost of drugs and

the private sector subsidies provide little or no benefit to

Medicare enrollees, yet they contribute to the rise in costs

both for beneficiaries and the federal government--and

accelerated the date at which the cap was reached.

Finally, the legislation submitted by the President in

response to the ``trigger'' could have devastating

consequences to Medicare beneficiaries with little oversight

by Congress. For example, Section 101(d) of the implementing

legislation directs the Secretary of the Department of Health

and Human Services to design and implement a new performance-

based reimbursement system for all Medicare providers as well

as a new ``incentive'' program intended to drive Medicare

beneficiaries to selected providers under this new system.

With this one provision, Congress would delegate to the

Secretary unprecedented authority to change the way the

Medicare program operates through the regulatory process,

rather than reserving such important decisions for Congress

and the Committees of jurisdiction.

The President's legislation also would dramatically expand

Medicare means-testing through a provision that has been

proposed repeatedly as part of the President's budget

submission only to be rejected by Congress. Section 301 of

the President's bill would expand means-testing to include

the Part D program, a policy which many experts believe would

be extremely difficult to administer, and further would not

allow the income limits to rise to reflect inflation. Income

limits that are not indexed ultimately affect far more people

than the ``wealthy'' they are originally designed to cover--a

fact well demonstrated by the current reach of the

Alternative Minimum Tax.

Medicare faces challenges in the future, but they are not

unique to the Medicare program--they reflect the same

pressures driving health care costs for those under age 65.

Addressing these challenges will not be advanced by a

contentious debate on the share of program costs funded

through general revenues. In fact, such a debate will

distract from the true challenge of Medicare: determining how

to provide high-quality health care for an aging population

in an era of rising health care costs.

We strongly urge the House to suspend the Medicare

``trigger'' by passing H. Res. 1368 and focus instead on

making health care affordable for all Americans.

Cordially,

Barbara B. Kennelly,

President & CEO.

Mr. Speaker, at this time I am very pleased to yield 2 minutes to the distinguished gentleman from North Dakota, a friend of mine and classmate, a member of the Committee on Ways and Means, Mr. Pomeroy.

Mr. Speaker, I am very pleased at this time to yield 2 minutes to the distinguished gentleman from South Carolina, who is the chairperson of the Budget Committee, my good friend, Mr. Spratt.

I yield the gentleman an additional 30 seconds.

Mr. Speaker, at this time I am very pleased to yield 2 minutes to the distinguished gentleman from California, who is the chairman of the Health Subcommittee, Mr. Stark.

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

Mr. Speaker, at this time I would yield to my good friend, the distinguished gentleman from California (Mr. Thompson), who is a member of the Ways and Means Committee, 2 minutes.

Mr. Speaker, at this time I am very pleased and privileged to yield 2 minutes to the gentleman from New York, who I feel knows as much or more about this issue than anyone, the chairman of the Committee on Ways and Means, Mr. Rangel.

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

Mr. Speaker, I am very pleased to yield 1 minute to the very distinguished gentleman from Texas, a member of my class and a member of the Committee on Ways and Means, Mr. Doggett.

I yield the gentleman an additional 1 minute.

I do not yield for that purpose.

I object.

I am going to be the last speaker.

Mr. Speaker, at this time I did have an additional speaker, and I would ask to yield 1 minute to the distinguished gentleman from California (Mr. Stark).

Mr. Speaker, I would inquire of my friend from California if he has any remaining speakers. I am the last speaker for our side, and I'm going to reserve my time until you have closed for your side.

Mr. Speaker, I yield myself the balance of the time.

Mr. Speaker, I have sat and stood here with great amusement as my colleagues on the other side of the aisle have come to the floor to oppose this resolution. After all, if it were not for their actions, this resolution wouldn't even be necessary.

The ``45 percent Medicare trigger'' was nothing more than a gimmick designed to gain the votes of conservative

Republicans for their Medicare prescription drug bill. It was drafted behind closed doors. I was here, Mr. Speaker. Mr. Rangel tried to get into their conference. They locked the doors without any consultation with Mr. Rangel of the Ways and Means Committee, members that were in the minority without any involvement or notification to the minority. It was then slipped into the conference at the last minute and had not passed the House or the Senate.

It's amazing, Mr. Speaker. My friends on the other side agreed to this trigger and preach fiscal responsibility and are now supporting a process which could force the House to allow legislation to the floor in clear violation of its PAYGO and earmark rules.

I was really amused that the distinguished gentleman that is head of the Republican Study Committee came in here as much as he talks about earmarks and is going to come here and talk about fiscal responsibility.

I was also amused that the last lady speaker who took it upon herself to talk about this measure but forgot, I guess, that she voted to override the President's veto last week.

But now they come to the floor to complain because their Members bought a pig in a poke. Give me a break.

The last time I checked, they were the dealer with all the cards in 2003.

Mr. Speaker, next Wednesday, Medicare will turn 43 years old. Since its founding, the program has provided health care to hundreds of millions of seniors, including my momma and my grandpapa.

Almost 35 percent of the people living in my district are senior citizens, and the overwhelming majority of them depend on Medicare.

Members have a choice today between reviving the Republican legacy of political and procedural gimmickry or standing up for seniors and sound public policy.

While Republicans choose to play games and engage in political hyperbole, my Democratic colleagues and I have chosen America's seniors.

I urge my colleagues to support this resolution.

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

The previous question was ordered.

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

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

Let me begin by expressing my appreciation to my good friend, my Rules Committee colleague from Fort Lauderdale, for yielding me the customary 30 minutes. And I have to say that I rise in strongest possible opposition to this rule. Only under this new majority, Mr. Speaker, could an attempt to ensure fiscal responsibility be described as nothing more than a procedural gimmick, and only under this new majority, Mr. Speaker, can we once again be taking action that totally subverts what we're all about here, and that is an open and fair debate.

At issue today is a provision enacted by Republicans to ensure that Medicare is administered in an effective and a responsible way. When we created the prescription drug benefits for seniors, we included a provision to require regular reports on how Medicare is funded. We wanted to know, is the Medicare trust fund sufficient to cover the costs? Or are we drawing from the general Treasury to pay for it? And if we are, how much? If two consecutive reports indicated that over 45 percent of Medicare's costs would come from the general Treasury over the next 7 years, Congress would have to act. We did not mandate what steps Congress would have to take. We simply required that solutions be examined, debated and brought to a vote, something that seems to be anathema to this new majority.

We believed this provision was critically important because we, as Republicans, have two very important goals for Medicare.

First, it must effectively provide health care coverage for our seniors. Second, Mr. Speaker, it must be run efficiently and responsibly.

Today we are confronting exactly the scenario that concerned us and led to this point. We have had two consecutive reports indicating that Medicare will exceed the cost threshold for years to come. In accordance with the law, the President submitted a proposal to restore fiscal discipline while ensuring that seniors continue to receive high quality care. Under the rules of the House, we are approaching the deadline to consider the proposal. But this new majority leadership, unable or unwilling to address runaway costs, simply wants to make this attempt at good governance go away, completely vanish. The rule before us today would quash the provision requiring us to consider a legislative fix. It allows runaway entitlement spending to continue unabated.

Naturally, our good friends on the other side of the aisle are going to try to distract us from the facts today.

They are going to rail against the circumstances, as we have already heard from my friend from Fort Lauderdale surrounding the original prescription drug vote in an attempt to obscure the real issue. This is a favorite trick of theirs, Mr. Speaker. The Democratic majority leadership cannot defend their own actions, so they stir up fights about Republicans. They can thunder away about 5-year-old fights all they want, but it won't absolve them of the actions that they are trying to take here today. Today they are in charge. They are responsible for their actions as the majority. They cannot distract the American people from the fact when they were presented with a proposal for reforming the cost of Medicare, they decided to change the rules and ignore the problem. That's exactly what is happening here.

Mr. Speaker, we have a legislative fix that was submitted by the President of the United States and introduced by the majority and the minority leaders as required by the fiscal discipline procedures put into place by Republicans in this important bill. It recommends two steps to rein in skyrocketing costs. One, it lowers the government subsidy for prescription drug coverage for high-income seniors to save $3.2 billion over 5 years. Second, it reforms the medical liability system and puts patients before trial lawyers, saving nearly $4 billion.

Now, Mr. Speaker, I don't know that that is the panacea, but those are a good start and those are the proposals that the majority leader and the minority leader introduced as required under this law.

I know some people may not like those savings. Some of my friends on the other side of the aisle are enamored with the present liability system and believe that we need more litigation, not less. Others may feel that everyone, regardless of income, should get the full prescription drug subsidy.

There may be disagreement on these issues, but they are worthy of consideration and debate, which is what this institution is all about. Debate is exactly what was envisioned by this proposal. It provided for at least ten separate alternatives, each debatable for up to an hour. My friend is absolutely right, it could take 10 hours, but God forbid we spend 10 hours discussing an issue as important as this. We imposed no restrictions. Any proposal for reining in costs could be considered and debated. This is a foreign concept in the 110th Congress, but we actually believe that open, rigorous debate is the key to finding solutions to our most difficult challenges.

Unfortunately, the rule before us today continues a very troubling pattern: the Democratic majority leadership would rather duck and cover than stand and deliver on a very important issue for the American people.

In case the American people haven't noticed, Mr. Speaker, the House of Representatives has been locked in a legislative holding pattern. We have at least five appropriations bills which have been ordered reported by the Appropriations Committee. How many

have been considered on the floor during this very important traditional appropriation month? Not a single one. Zero. Nada. None.

The same is true for real energy legislation. Oh, we've had fig leaves on the floor like the one we had just a couple of hours ago. But the majority is not interested in debate on these measures. They bring controversial energy legislation that no one has ever seen to the floor, and then they impose ultra-restrictive rules so that Republicans, or Democrats, cannot offer their own ideas.

These flawed bills fail, of course, but the Democrats get to avoid a real debate on the important issues of conservation, alternative energy sources, and yes, new domestic supplies of oil.

This pattern continues today with this rule. Instead of having a real debate on legislation to reform the Medicare program, we are using the rules to completely avoid the program altogether.

The reason, Mr. Speaker, is simple. The Democratic majority leadership is more concerned about protecting their Members from tough votes than engaging in the honest and open debate they promised the American people when they won the majority nearly 2 years ago. They are more interested in maintaining their electoral fortunes than tackling the tough business of actually governing.

Now if press reports are to be believed, the Democratic majority plans to avoid the most basic responsibility we have as legislators: making decisions about our spending priorities. Instead of doing the business of passing appropriations bills and considering legislation on key issues like how we can get gasoline prices down and how we deal with Medicare, they are going to punt all of the tough choices until the next administration. I am just shaking my head and asking, Mr. Speaker, what is it that we are doing here and what is it that we are afraid of when it comes to doing our work in this 110th Congress?

We have an opportunity right here and right now to break this pattern. If we defeat this rule, we can have a real debate on alternatives to reform Medicare spending. We can start the business of governing and have a real debate on the real issue of fiscal responsibility, which is exactly what this provision is all about.

But if we pass this rule, it is another blow to responsible government. It is another example of how far the Democratic majority leadership has fallen from the principles that they ran on and promised the American people nearly 2 years ago.

Mr. Speaker, I urge my colleagues to vote ``no'' on the previous question and vote ``no'' on this rule.

Mr. Speaker, I am happy to yield 1 minute to the very distinguished gentleman from Westchester, Ohio, our distinguished Republican leader, Mr. Boehner.

Mr. Speaker, at this time I am happy to yield 3 minutes to

the very distinguished ranking Republican on the Committee on Ways and Means, the gentleman from Shreveport, Louisiana (Mr. McCrery).

Mr. Speaker, I just want to say we have a wide range of choices as to how we can cut spending.

At this time I am happy to yield 2 minutes to my very distinguished friend, the gentleman from Springfield, our distinguished Republican whip, Mr. Blunt.

I am happy to yield my friend an additional minute.

Mr. Speaker, may I inquire of the Chair how much time is remaining on each side.

Mr. Speaker, obviously, through this extraordinary process, there is such a demand for time. We have so many committees of jurisdiction. It is a real challenge. We have only 14 minutes remaining; is that it?

At this time I am happy to yield 3 minutes to the distinguished ranking member of the Committee on Budget, the gentleman from Janesville, Wisconsin (Mr. Ryan).

I yield myself 10 seconds, Mr. Speaker, to say to my very good friend that if, in fact, he is willing to have a debate any time on this issue, what he needs to do is vote ``no'' on this rule so that we can proceed with that debate.

At this time I am happy to yield 3 minutes to the very distinguished chairman of the Republican Study Committee, my friend from Dallas, Mr. Hensarling.

Mr. Speaker, at this time I am happy to yield 1\1/2\ minutes to my very good friend from Midland, Michigan, a hardworking member of the Ways and Means Committee, Mr. Camp.

Mr. Speaker, would the gentleman yield? I would be happy to yield additional time if my friend would yield to me.

You yield to me, and then I would be happy to yield additional time.

That is exactly what my friend is arguing, and I am here and willing to do just that, on this issue and every single other issue.

I am happy to yield to my friend 30 seconds.

I took 2 seconds and I'm yielding him 30. That's a pretty fair deal.

May I inquire of the Chair how much time we have remaining on each side.

At this time I am happy to yield 1\1/2\ minutes to my very good friend who is a former member of the Rules Committee, Mr. Gingrey.

Mr. Speaker, may I just inquire of my friend how many speakers he has on his side.

I have got to say that before I do, Mr. Speaker, we have the Committee on the Budget, Ways and Means, Energy and Commerce, the Rules Committee, all of which have jurisdiction on this. We've been limited to 30 minutes of debate on this side, and I just wondered if he might be interested in propounding a unanimous consent request that we extend the debate by maybe 5 minutes on each side.

The gentleman is going to have to object. I was asking unanimous consent if we might.

Mr. Speaker, so may I inquire again as to how much time is remaining on each side, Mr. Speaker.

May I just inquire how many speakers are on the other side.

At this time, Mr. Speaker, I am happy to yield 2 minutes to my very good friend from Georgia (Mr. Price).

(Mr. PRICE of Georgia asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield myself 20 seconds to say to my friend that we have been constantly arguing that we're willing to sit down and talk about this and debate these issues at any time. And we're willing, and the two top dogs on the Ways and Means Committee have both said they're willing to do that; and we've been willing all along. And that's exactly what this provision is all about.

The fact of the matter is the tax cuts that have been put into place dramatically surge the flow of revenues to the Federal Treasury. We all know that. And we have a responsibility to look at anything we possibly can to bring about a fiscally responsible Medicare program and we're going to do that.

With that, Mr. Speaker, I would like to yield 1 minute to my very good friend from Tennessee (Mrs. Blackburn).

Let me say, Mr. Speaker, that we very clearly have an opportunity before us. We have an opportunity to defeat this rule so that we can do what it is that we came here to do. We have had a wide range of recommendations that have come here from the Medicare commission. And we have a proposal that is before us submitted by the majority leader and the minority leader as required under this law. It made two very important recommendations dealing with liability reform in ways which we could bring about fiscal responsibility of Medicare. That's what our charge is. That is what our job is as Members of the United States Congress.

The action that we are about to take in this House is to simply sweep it under the rug and pass off to the future what we were sent here to do right now. We're rapidly approaching the date by which time we need to begin taking action. That is July 30. And our colleagues, unfortunately, have chosen to turn their back on those who want to bring about a fiscally responsible solution to a challenge that we all know is looming.

Mr. Speaker, I urge my colleagues to defeat this rule so that we can move ahead and do the right thing for our seniors and for future generations.

With that, I yield back the balance of my time.

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

Mr. Speaker, I have some prepared remarks, but I want to address a couple of things that have been said, because I think it's important for the House to understand.

Number one, the gentleman from Florida said that we have already solved this problem, and he is right in one sense. There was enough of a pay-for in the last Medicare bill that we passed, that had we couched it properly, we could have used as a pay-for to get us within the window required by MMA, but we didn't do that. We didn't go through the proper procedure. So to suggest that we now can just do away with the rule because in some other bill we created enough funding that would have worked had we followed the proper procedure, I think, is a very tenuous argument.

The whole purpose of the provision, and the second thing I want to address, is this notion that this was slipped in in the dead of night, and it was just totally a Republican effort to somehow kill Medicare. I would say to the House that this suggestion was first made by the National Bipartisan Commission on the Future of Medicare that was chaired by Bill Thomas and John Breaux, a Republican and a Democrat.

So we didn't come up with this in the dead of night. It is something that had been circulating, and I thought it was a good idea then, I think it's a good idea now. It's regrettable that the House stands ready today to dispose of this very worthwhile rule.

All the rule was intended to do, it wasn't intended to kill Medicare. What it was intended to do is force us to face the problem every year, because we all know, those of us who are familiar with the program, familiar with the structure of the program and the financing of the program, know that more than 45 percent of general revenues are going to be used to pay the costs of this program very soon. Then it will be every year, and it will grow.

In fact, if we allow this program to go on autopilot, it will grow from about 2.7 percent of GDP this year to over 14 percent of GDP by the end of the 75-year CBO window, over 14 percent. We only take in in revenues, total revenues, between 18 and 19 percent of GDP. So if we allow this program to just go like it is now without discussion or debate or reform, we are going to have to do away with most spending for defense, education, roads, highways, unless, of course, we have a dramatic increase in taxes.

Mr. Speaker, I appreciate the opportunity to tell this House that the product would be irresponsible.

Mr. Speaker, I strongly urge my colleagues to vote against this irresponsible change in the rules of the House.

The resolution before us today would prevent the House from having to hold any debate about the looming financial crisis facing the Medicare program. Apparently, the Democrats don't want to talk about reforming a program that is slated to go bankrupt in 2019.

This rules change isn't about a specific proposal to change Medicare. What it would do is repeal a bipartisan provision that would force Congress to at least take note of Medicare's increasingly unsustainable financial situation and begin to consider solutions.

But instead of having an open discussion about how to address the out-of-control costs of this program, today's resolution allows the Congress to bury its head in the sand and kick the can down the road, letting a future Congress deal with this ever worsening problem. This is irresponsible.

The facts are clear. Medicare is facing bankruptcy. The combination of rising health care costs and an aging population have created a financial hurricane on the not-too-distant horizon.

Last year, Medicare spending totaled about 2.7 percent of our GDP. That figure will more than double by 2030 and hit 14.8 percent by the end of the CBO's 75-year budget window. Since total federal revenues, historically, have been between 18-19 percent, it is clear we cannot let Medicare spending increase on auto-pilot unless we are willing to substantially raise taxes or cut all other government spending.

The need for structural reform of Medicare is not just Republican rhetoric. In recent testimony before the Ways and Means Health Subcommittee, the non-partisan Medicare Payment Advisory Committee (MedPAC), which was created by Congress to advise us on Medicare payment issues, said that, ``The [Medicare] program's shaky financial outlook is a strong impetus for change.''

Now my colleagues on the other side of the aisle will claim that this 45 percent trigger was created by Republicans as a way to privatize or block grant the Medicare program. Let me remind them that this policy was first suggested by a bipartisan Medicare task force that was chaired by Democratic Senator John Breaux.

And let me also point out that there are many ways that we could solve this problem. But ducking it is surely not on that list.

Mr. Speaker, I urge my colleagues to reject this rule change. This problem will not go away just because we ignore it. The longer we wait to address it, the more difficult the solution will be.

I thank my good friend for yielding.

Mr. Speaker, I heard my good friend say we ought to deal with this in the next Congress, and I wonder why, why the next Congress. Why not this Congress? The reason we are having this critical we must vote today, vote right now, is that we haven't taken advantage of this opportunity to move forward on reform. The notice came up weeks ago. In fact, the notice came up months ago, and that's when the majority could have brought a great debate to the floor instead of the debate about whether we should debate or not.

Over a decade ago, Congress created the National Bipartisan Commission on the Future of Medicare. One of the recommendations of the commission was to require a trigger so that the Medicare trustees in Congress will have to publicly debate whenever the Medicare program is in danger of becoming insolvent. The trigger is one of the many recommendations of this commission, not ideas just out of thin air, recommendations of this commission that were formally adopted as part of the Medicare prescription drug bill in 2003.

But this Congress seems to never miss an opportunity to miss an opportunity. I am very disappointed that the Democrat leadership has halted consideration of key legislation designed to safeguard the future of Medicare, reconsideration, in fact, that's required by law unless we today vote to say we

are not obeying that law. If not obeying that law is the right thing to do, I don't know what could be more important than having a discussion on the future of Medicare, unless it would be the future of energy, and we are not having that discussion either.

Let's debate it, let's talk about it, let's see what we can do. One of the ideas that we have put forward that apparently is particularly fearsome is medical liability reform. If this rule passes, we will avoid being forced to debate and vote on lawsuit abuse and its impact on seniors, taxpayers and doctors. Such a reform will lower health care costs for all Americans and save Medicare $4.8 billion over the next decade.

They don't want to debate means testing for wealthy seniors or more competition to serve patients. We could be doing all of those things today. We could be doing none of those things today. We could be debating whatever the majority wants to debate.

The point is we could be having a debate about the future of Medicare. First, we are afraid to debate energy. Now we are afraid to debate Medicare. What are we willing to debate on the floor of this House?

I want to have that debate. I oppose this vote to run away from those solutions.

Mr. Speaker, I would like to submit in the Record the statement of the Health Coalition on Liability and Access on this legislation. That states that medical liability reforms are a central part of reducing costs and improving access and quality in the Medicare program.

[From the Health Coalition on Liability and Access, July 24, 2008]

Statement From HCLA Chair on Medicare and Medical Liability Reform

Washington, DC.--HCLA Chair Shawn Martin issued the

following statement regarding today's Congressional vote on

Medicare:

``Today Congress will consider legislation pertaining to

the so-called ``trigger'' provision of the Medicare

Prescription Drug, Improvement and Modernization Act of 2003.

Complying with the law's requirements, the President has put

forward legislation, which includes medical liability

reforms, to address the Medicare funding issue. The Health

Coalition on Liability and Access believes that medical

liability reforms are a central part of reducing costs and

improving access and quality in the Medicare program.

``Medical lawsuit abuse drives up the cost of medicine for

everyone. In fact, it's estimated that medical liability

reform would save Medicare $4.8 billion annually, not

including savings from reductions in the practice of

defensive medicine.

``Comprehensive medical liability reforms have a proven

track record of success at the state level of reducing health

care costs and increasing patient access to quality medical

care. Controlling our nation's Medicare costs is one more

reason America needs national medical liability reform.''

Mr. Speaker, I rise today to praise the passage of the Paul Wellstone Mental Health and Addiction Equity Act (H.R. 1424)-- a bill that will fill the longstanding gaps in mental health care in this Nation and that will end the unfortunate disparate treatment that patients seeking mental health care currently receive.

Mr. Speaker, as a physician who practiced for more than two decades prior to coming to Congress, I have seen what happens to people who are afflicted with mental illnesses like bi-polar disorder, depression, and schizophrenia who do not receive appropriate, consistent care.

Studies confirm that mental health is integral to the holistic health and wellness of all people. Additionally, under-addressed mental health care issues are not just issues that affect the individuals who live with mental disorders; they also affect their friends, families, and communities. And, today, statistics show that 1 in 17 Americans suffer from a serious mental health disorder and that these disorders are the primary cause of disability in the United States among people 15 to 44 years of age--during their most productive life years.

Despite the enormous impact that mental illnesses can and do have on millions of Americans every day, good treatment works. But, of course, the treatment options available to patients comes with a cost and one that up until now has had to be borne largely by the consumer. It is important to recognize though that the cost of mental health problems-- when they are un- and under-addressed--becomes staggering.

The good news is not only that over the past eight years, the Federal Employee Health Benefits Program (FEHBP) has made ``parity'' coverage for mental health care available to Members of Congress and 8.5 million other Federal employees, but that there has been no significant cost increase to this parity requirement in FEHBP. Based on this and further analysis, the nonpartisan Congressional Budget Office has estimated that H.R. 1424 would have a miniscule impact on premiums--just two- tenths of 1 percent.

For the sizeable proportion of Americans that suffer from more than one mental health disorder at a given time, this bill will be critical in improving mental health care access, options, and treatments available to patients seeking services.

Certainly, there is no better time than now to ensure that patients seeking treatment for mental illnesses are able to do so in a system that champions mental health parity, where care is accessible and not subject to reimbursement limitations by insurers or group health plans. This bill is exactly what is needed to finally bring equity and fairness into the mental health care system in this Nation and to finally make the health care that individuals can receive comprehensive.

Finally, Mr. Speaker, I also want to add that as the chair of the CBC Health Braintrust, I have long been concerned by the racial and ethnic disparities in mental health and in mental health care that detrimentally affect the millions of innocent, hardworking Americans, and have long championed and supported legislation to reduce such disparities.

The Paul Wellstone Mental Health and Addiction Equity Act is a bill that will help reduce the disproportionate burden of mental health and mental health care disparities on African Americans and other people of color.

Mr. Speaker, the burden of mental illness on the health and productivity in the United States and throughout the world has long been underestimated. This is a situation that demands and needs immediate action, for all children and adults who live with mental illness. Enacting strong mental health parity legislation will improve the health status of individuals who suffer dire health consequences as a result of their mental illness and pushes us one step closer to achieving health equity.

I am pleased that the House passed H.R. 1424. Now we can move forward to eliminate all disparities in health care by passing H.R. 3014, the Healthcare Equity and Accountability Act.