Transportation Flexible Savings Accounts Act of 2009

Mr. Speaker, I move to suspend the rules and agree to the resolution (H. Res. 971) expressing the sense of the House of Representatives regarding guidelines for breast cancer screening for women ages 40 to 49.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend remarks and include extraneous material in the Record.

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

Mr. Speaker, I rise today in support of House Resolution 971. This resolution expresses the sense of the House of Representatives that the U.S. Preventive Services Task Force guidelines would not prohibit an insurer from providing coverage for mammography services beyond those recommended by the task force.

It further states that these guidelines should not be used by insurers to deny coverage for these services.

It also expresses the sense of the House that the National Cancer Institute should continue to invest and provide leadership regarding research to develop more effective screening tools and strategies for improving the detection of breast cancer.

On November 16, 2009, the U.S. Preventive Services Task Force issued a series of six recommendations regarding breast cancer screening, three of which pertain to mammography screening among women of various age groups. At a recent hearing in our Energy and Commerce Committee's Health Subcommittee, the task force representatives acknowledged that they should have done a better job communicating their findings to the public. Unfortunately, this failure in communication has led to much concern and confusion about what their findings and recommendations are and what the implications would be.

Mr. Speaker, this task force is not suggesting that women in their forties forego mammography. The task force is recommending that women in their forties determine when to begin screening and base this decision on a conversation with their doctors or health providers. And we can all agree that women in their forties should have access to mammography if these women and their physicians decide it's right for them. I think we can also agree that while mammography is still the best tool that we have to detect breast cancer in its earliest stages, it is, by every means, an imperfect tool. We need continued research into more effective screening tools and strategies to improve the detection of breast cancer.

Breast cancer is the second most common cancer among United States women, and it is the leading cause of cancer death for women between the ages of 29 and 59. This year, new cases of breast cancer among American women will reach an estimated 192,370, and over 40,000 women will die from breast cancer this year. The American Cancer Society estimates that one in 8 women will have invasive breast cancer at some point in her lifetime. These statistics illustrate that breast cancer

continues to be a major health issue, despite recent declines in breast cancer mortality rates.

But beyond these statistics, cancer is a very personal situation for many of us in this Chamber, whether it has affected a mother, a daughter, a wife, a friend, a colleague or, as it has for me, my own sister. I want to commend my colleague, Debbie Wasserman Schultz, for introducing this resolution and for being so forthcoming about her very personal experience being diagnosed with and treated for breast cancer.

I reserve the balance of my time.

Mr. Speaker, I wish to remind my colleagues that in the health reform bill, as it was considered in the House of Representatives, once the essential benefits package is established, it acts as a floor, not as a ceiling. And with regard to preventive services, the bill says that recommended items and services with a grade of A or B from the U.S. Preventive Services Task Force shall be covered as part of the essential benefits package, with no cost- sharing, and that the Secretary may approve such coverage, regardless of what the task force or the benefits advisory committee says.

And at this point I'm very pleased to yield to Representative Wasserman Schultz, the sponsor of this legislation, 5 minutes.

Mr. Speaker, may I require of the remaining time on this side?

At this time, it's my pleasure to acknowledge and I yield to the Congressman from New York (Mr. Engel) 2\1/2\ minutes.

Mr. Speaker, I would remind my colleague that at the hearing 2 weeks ago at the Energy and Commerce Committee, the breast cancer stakeholders were asked a simple question: Would H.R. 3962, the health reform bill, help women with breast cancer? Every witness on that panel, including the American Cancer Society, Komen, the National Breast Cancer Coalition, the American College of Physicians, every witness on the panel agreed that this bill, the health reform bill, will help women to prevent and women who already have breast cancer.

And at this point, I'm very pleased to yield 2 minutes to my colleague and a big supporter of the Breast Cancer Caucus, Jerry Nadler.

Mr. Speaker, I am very pleased at this point to yield 1 minute to our colleague from Indiana (Mr. Donnelly).

Mr. Speaker, I am now pleased to yield 1 minute to our colleague from Pennsylvania (Mrs. Dahlkemper).

I am pleased to yield the gentlewoman an additional 30 seconds.

Mr. Speaker, may I inquire again as to the time that remains on our side.

Mr. Speaker, at this point, I am very pleased to yield 1 minute to our colleague from Florida (Ms. Kosmas).

I am pleased now to introduce and to acknowledge my colleague from Virginia, Congressman Connolly, for 1 minute.

I have two additional speakers.

I am very pleased to yield 1 minute to our colleague from Colorado, Congresswoman Markey.

I am now pleased, Mr. Speaker, to yield to our colleague from Illinois, Congresswoman Halvorson, 1 minute.

Mr. Speaker, in yielding back our time, I remind our colleagues that the truth is, when enacted into law, H.R. 3962 will result in millions of uninsured Americans receiving their first mammogram and will no longer face being dropped by their insurance company if they are diagnosed with cancer.

I wish to acknowledge and thank the leader of this resolution for her hard work, our colleague, Representative Wasserman Schultz.

Ms. DeLAURA. Mr. Speaker, I urge my colleagues to support this resolution, H.R. 971, which helps to clarify much of the unnecessary furor over mammograms we have experienced of late.

The recent breast cancer recommendations by the U.S. Preventive Services Task Force effectively said that women ages 40 to 49 should have a conversation with their doctors before deciding to have a screening mammograms. In other words, they were to attempt to put as much information as possible in the hands of women and their doctors, so they can assess their own risk and benefit.

Now, whatever decision women come to on this important matter, they need two things to ensure they have access to mammography should they decide to get screened: One is a quality health coverage so they have a doctor they can go speak to. And the second is coverage for mammograms and other important preventative services. And, of course, some women will need coverage for treatment if a cancer is found.

This is why I support this resolution, which argues that insurers should not deny coverage for mammograms for women ages 40 to 49 who decide to get screened. This is also why I support comprehensive health insurance reform, so that women can afford health care in the first place, and get coverage for that mammograms and any follow-up treatment they might need.

We must redouble our efforts across the board to ensure that Americans are getting the appropriate preventive screenings. Right now, according to the Centers for Disease Control and Prevention, only 25.9 percent of women ages 50 to 64 have received all the recommended preventive care for breast, cervical, and colorectal cancer, as well as influenza. Under health reform, women would finally get the preventive care they need.

In the meantime, there is a great need for more information, more research, and more scientific innovation to help women prevent, detect, and fight breast cancer, the second leading cause of cancer deaths among women. This resolution also urges the National Cancer Institute to continue to invest in research toward more effective screening tools and strategies for improving detection of breast cancer.

For all of these reasons, I strongly urge my colleague to support this resolution. Mammography is not perfect, but right now it is the best method we have to detect this killer in our midst. We need to make sure that as many women as possible have access to this important, life-saving procedure, and that better, safer screening procedures will soon be forthcoming.

I yield back the balance of my time.

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

Mr. Speaker, I do rise in support of the resolution, and I yield myself such time as I may consume.

I am pleased to see this resolution before us, and I want to commend Congresswoman Wasserman Schultz and also Congresswoman Capps for their work on this issue. I appreciate their leadership to raise awareness, and I have grave concerns, very grave concerns on how this issue translates into the health reform bills that are currently before us. While I do rise in support of this, I do think that it is important, it is imperative, as a matter of fact, that we revisit why we are here and why we are having this discussion today. And it's important that we realize that, even with the resolution before us, it is not going to get to the crux of the issue, but it is a good, solid first step.

With or without a government-run health plan, H.R. 3962 would still be a massive takeover of health care. Government bureaucrats will be charged with making decisions of what can be in your health plan, and they can make it illegal for a health plan to cover anything not approved by the government. In the House version of the Democrats' health reform, the U.S. Preventive Services Task Force and its successor organization are cited over a dozen times and given disturbing new authority over coverage decisions regarding breast cancer screening.

For example, on page 1,762 of the Democrat health reform bill, the U.S. Preventive Services Task Force is given the authority to determine, and I'm quoting, ``the frequency'' and ``the population to be served.'' And quoting again from the bill, ``The procedure or technology to be used for breast cancer screenings covered under the Indian Health Service Act.'' Section 303 of H.R. 3962 states that the, and I'm quoting again, ``Commissioner shall,'' which is a mandate, Mr. Speaker, ``shall specify the benefits to be made available under exchange participating health plans.''

In plain English, that means the new health choices commissioner will determine what preventive services, including mammography, are covered under your health insurance based on what the task force says is right. Passing a resolution and passing this resolution before us, as I said, is a good, solid first step. However, I do believe to strike at the heart of the problem we, indeed, need to move forward on a motion to instruct conferees to make certain that we revisit this issue.

Under the Democrats' bill, the task force will set government policy and will determine what is covered and make it illegal for plans to cover other items. All recommendations of the Preventive Services Task Force and the Task Force on Community Preventive Services as in existence on the day before the date of the enactment of this act-- which would be H.R. 3962--shall be considered to be recommendations of the Task Force on Clinical Preventive Services.

Mr. Speaker, in order to prevent any type of rationing, that is why we need to take even further steps. I commend my colleagues for their diligent work on this issue. It is the right first step, and I encourage all of us to continue to work to resolve the issue.

I reserve the balance of my time.

Mr. Speaker, at this time, I am pleased to yield 2 minutes to the gentlewoman from North Carolina (Ms. Myrick), who has been a true champion of women and breast cancer issues and has really led on our side of the aisle as we have worked to deal with so many of these issues.

I yield the gentlewoman 30 additional seconds.

Mr. Speaker, at this time, I yield 3 minutes to the gentleman from Michigan (Mr. Rogers),

who has been a leader in the health care debate on our Energy and Commerce Committee.

I yield the gentleman 30 additional seconds.

Mr. Speaker, at this time, I yield 3 minutes to Dr. Gingrey, the gentleman from Georgia who has practiced medicine, obstetrics and gynecology, has worked with women and women's health care issues, and joins us on the Energy and Commerce Committee.

Mr. Speaker, at this time, I yield 1\1/2\ minutes to the gentleman from New Jersey (Mr. Lance).

At this time, I yield 1\1/2\ minutes to our ranking member on International Affairs, Ms. Ros-Lehtinen from Florida.

At this time, I yield 1\1/2\ minutes to Mrs. McMorris Rodgers from Washington State, who is vice chair of our conference.

I have an inquiry, Mr. Speaker. Is the gentlewoman from California prepared to close or does she have additional speakers?

I continue to reserve the balance of my time.

Mr. Speaker, I think that all of us come here because of our concern, great concern, about women and mammography and the health care issues that are found before us.

When it comes to breast cancer, we are very grateful for early detection. We know it's important. Because of that, it is with great sadness that we have read what is in this bill.

In H.R. 3962, it clearly shows how the recommendations will limit America's choices and women's choices. Reading through the bill, section 2301 does establish the Task Force on Clinical Preventive Services, and it clearly says that A and B are priority levels for these treatments. You can read on page 1,318, and I do, Mr. Speaker. It says in line 2, the Commissioner shall ensure--shall ensure--that A and B is going to be the rating that is covered, but C is not.

What we are discussing in this 40 to 49 age group is those C ratings, and the Commissioner will not have the power to downgrade that decision. Section 222 of the bill--what you have in this resolution is going to be negated by section 222 of the bill that says the services designated A or B priority are part of the essential benefits package. So just saying that the guidelines would not prohibit an insurer from providing coverage, your own legislation is going to end up negating that, if that is signed into law.

The language of this bill is clear. All insurance providers must offer A and B priority services. They have no incentive or a mandate to offer priority C or below. That is where it affects women under 50 and women over age 75, and those, indeed, are valuable lives.

Mr. Speaker, we do look at this legislation. We look at section 2301 where it says that, All recommendations of the Preventive Services Task Force and the Task Force on Community Preventive Services, as in existence on the day before the date of the enactment of this Act, shall be considered to be the

recommendations of the Task Force on Clinical Preventive Services.

At that point, Mr. Speaker, unfortunately, they are going to have the full weight of law behind them. It is in the bill.

Yes, we look at this, and we see the bureaucrat in the exam room right here. We look at it, and we all know and have loved and have held family members in our arms that have been affected and would have lost their lives had they not had access to early detection. It concerns us.

Do not ration health care. Support the resolution, but let's go further in getting out of the bill.

I yield back the balance of my time.

Mr. Speaker, today I rise to support House Resolution 971, which underscores the importance of access to breast cancer screening for all women.

As many of you know, last month the United States Preventive Services Task Force issued guidelines regarding mammography screening for women. These guidelines reflect a change from USPSTF mammography recommendations that were issued in 2002, in that they recommend against routine screening mammography for women ages 40 to 49. But the new guidelines conflict with many of the well-established recommendations from the American Medical Association, the National Comprehensive Cancer Network, the American Cancer Society, and Susan G. Komen for the Cure.

In addition, numerous studies and scientific research over the past 20 years have confirmed that annual mammograms are of value to women ages 40 to 49. In fact, the task force itself concluded that screening women in their forties would reduce their risk of death from breast cancer by 15 percent, while finding that screenings for women in their fifties would reduce their risk of death from breast cancer by 14 percent. As a result, many young women and health care providers have been left feeling uncertain and concerned.

Recommendations like those the task force made are supposed to provide clarity for doctors and their patients. Unfortunately, the guidelines issued by the task force left most women and oncologists baffled. Currently, there is no available breast cancer screening tool that is perfect, but what is clear is that intervention through routine screening for breast cancer using mammography can save the lives of women at a time when medical science is unable to prevent this disease.

At the end of the day, mammography screening saves lives. And I offer this resolution to underscore the House's commitment to expanding access to preventive health care for women. This resolution underscores the sense of the House that the task force recommendations must not be used by insurers who are, at the end of the day, getting in between women and their doctors and getting women the access that they need to preventive services, and that they must not be used by insurers to deny women coverage for routine screenings.

It also urges the National Cancer Institute to invest and provide leadership to provide research to develop more effective research tools and strategies for improving the detection of breast cancer.

While we develop better tools for screening, we cannot leave certain women, particularly young women, with nothing, which is what the task force recommendations essentially did.

To be sure, while we have come a long way in the fight against breast cancer, we still have a long way to go. This year, in the United States alone, over 190,000 women will be diagnosed with breast cancer; 40,000 of them will not survive. That is why we cannot rest in our efforts to fund research and find a cure for this vicious disease, and it is why we cannot rest in our efforts to provide education and awareness for all women. We must ensure that they have access to screening and treatment, and we must ensure that we do all we can to support the more than 2\1/2\ million survivors that live in our country alone today.

As many of you know, and has been gratefully acknowledged, I recently had my own battle with breast cancer, and I am so grateful and humbled to count myself among this growing group of survivors. I was fortunate to have the access to the treatment and support that I needed to win my own fight. I urge my colleagues to vote in favor of this resolution to make sure that everyone has that same opportunity.

Mr. Speaker, since the task force issued these guidelines, I have spoken to so many young survivors who have

been left feeling so frustrated and as if their lives somehow mattered less than the lives of older women. And this resolution sends a message to those young women across America today that that is not so, that the House of Representatives, that the United States Government, cares about all women's lives.

And with all due respect to my good friend, Mrs. Blackburn, whom I greatly respect and I appreciate your support for this resolution, what this resolution does not do, and what the task force guidelines do not do, and what our health care reform bill does not do, is it does not ration health care. The gentlelady, if she reads the text of the health care reform legislation more clearly, will see that our language in our health care reform bill is a floor. The gentlelady should know that the Secretary of Health and Human Services can go beyond the task force's recommendations, that they can go further, and that at the very least the health care reform bill that we passed off the floor of this House ensures that women get access, all women get access to the appropriate preventive screening that they need and ensures that that coverage is free. And the Health and Human Services Secretary can go even further than those task force recommendations that are labeled at an A and at a B level.

And with that, Mr. Speaker, I appreciate the indulgence of the leadership and the support of my colleagues. And I want to particularly single out the colleague that sits to the left of me for being a leader on issues that are important to young women who are diagnosed with breast cancer. He has been an incredible advocate for young women survivors, and I greatly appreciate it.

Mr. Speaker, I rise in support of H. Res. 971, expressing the sense of the House of Representatives regarding guidelines for breast cancer screening for women ages 40 to 49. I appreciate the leadership of the bill's author, my Judiciary Committee colleague Representative Wasserman Schultz.

This resolution was introduced on the heels of new breast cancer screening guidelines issued last month by the U.S. Preventive Services Task Force (the ``Task Force''), an independent panel of medical experts. These new guidelines have created cause for concern by some due to the change from the Task Force's 2002 mammography recommendations concerning mammography screening for women age 40-49.

In light of this concern, this resolution underscores the sense of the House that the Task Force recommendations should not prohibit insurance companies from providing mammography services in addition to those in the Task Force recommendations, and should not be used by insurers to deny women coverage for routine screenings. This resolution also urges the National Cancer Institute to continue to invest and provide leadership regarding research to develop more effective screening tools and strategies for improving detection of breast cancer.

This is not the first time recommendations about the use of mammography and breast self exams have been revisited--by the Task Force or NIH or any number of cancer-related research or advocacy groups. Just as we have seen with prostate cancer screening, immunization schedules, and other preventative care measures, new interpretations often result in a change in what experts tell us works most effectively. As the science of medicine evolves, so too, should the recommendations on the best use of that science.

Evolution and improvement are what the U.S. Preventive Services Task Force set out to achieve in undertaking a review of its 2002 mammography guidelines. The Task Force sought to take a fresh look of what has been learned over the last several years, and based upon that body of work, to provide its best professional judgment on what doctors and their patients should consider when they are making decisions about breast cancer screening. Despite the contention on this issue, I trust that the Task Force's deliberations and conclusions were driven by science and not by cost or insurance coverage.

Not withstanding the scientific basis for these new guidelines, I share the concern of Ms. Wasserman Schultz and others such as the Susan G. Komen for the Cure Advocacy Alliance who point out that one-third of all American women do not undergo regular screening. Many of those who go without screening are African American and younger women. According to the Susan G. Komen for the Cure Advocacy Alliance the failure of age-appropriate women to undergo mammography costs lives and reflects problems with access to care and breast cancer education.

Mr. Speaker, we need to work as rapidly as possible to correct these deficiencies, and continue to fund research and education designed to eliminate health care disparities. We want to eliminate any impediments to regular mammography screening for women age 50 and below. While there may be disagreement about the exact timing of breast cancer assessments, I believe there is unanimous consensus over the importance of guaranteeing access to screening.

New screening approaches and more individualized recommendations for breast cancer screening are urgently needed. I support research initiatives designed to improve screening, and believe that it is imperative that this research move forward rapidly. Furthermore, I encourage African American and other women with unresolved questions about breast cancer screening to engage in discussion with their health care providers.

If the new guidelines have done nothing else, I believe it has at least raised awareness, not only amongst women, but amongst all Americans. As such, I encourage my colleagues to support this bill.

Mr. Speaker, I want to thank Debbie Wasserman Schultz for her courage to get up here and talk about her ailment. I, too, am a cancer survivor, and it is a difficult process. But my concern is greater than even our own personal experiences. It is what is the actual result of that health care reform bill that leads us to this resolution.

We are scrambling around on the floor today to say that a government- appointed commission, this task force, has made a recommendation based on quality of year lives and cost, not good science, not that what saves lives, that women between 40 and 49 need not get mammograms. And you say, listen, that doesn't mean rationing. It doesn't mean anything. It doesn't have any weight of law. But guess what? The health care reform bill that passed this House makes those recommendations law.

Let me read a couple of quick things, Mr. Speaker, if I may. By the way, you have to go to three different sections, two different complete books, to understand how this impacts real women in America, some 2,000 pages into it.

One section: Limitation on individual health insurance coverage may only be offered on or after the first day of year one as an exchange- participating health care plan. Pretty fancy Washingtonspeak.

Let me tell you what it means in another section of the bill about 1,000 pages later: A health plan is prohibited from offering coverage for benefits not included in the essential benefits package.

And you say, Oh, no that's a floor.

It's not a floor. The language in the bill goes on further. And do you know what it does? It says that the only difference between the levels of plans is the amount of cost sharing, not what it covers.

Here is the scary part, of which I don't think you all realize that you did to about 47,000 women in America: All recommendations of the Preventive Services Task Force and the Task Force on Community Preventive Services as in existence on the day before the date or the enactment of this Act shall be considered to be recommendations.

The bill goes on to say that they must use that in the calculation of benefits. Guess what? Forty-seven thousand women who are under the age of 50 today will be diagnosed with late-stage breast cancer because of your bill. It's in your bill. It's in your language. Do you know what that means? Eighty percent of them will die because of their diagnosis.

Do you realize that more women will die because of this bill than we lost men in the Korean War? And I know you think, Oh, scare tactics.

No. It's the bill. But do you know what? You can't read it on page 1 or 2. You have to keep going back and forth in 2,000 pages to understand the full impact of what will happen to women who are 40 to 49 years old.

You did it in your bill.

I am going to plead with you. For the lives of 37,000 women who will die and 47,000 women, according to the recommendations of this task force which you make law----

I am going to plead with you, please read the bill, not just 1 to 2,000. Go back to the other sections and understand its full impact.

And you say, It won't happen in America. Guess what? This task force recommendation resulted on December 2 in California prohibiting low- income women under the age of 50 from receiving mammograms. It is happening today. This task force is doing it today. With your bill, it becomes law. They are prohibited. And it is illegal for them to get coverage other than what the government says they can get. And guess what? Mammograms don't qualify for women 40 to 49. Please think of those women and those families.

Announcement by the Speaker Pro Tempore