Providing for consideration of the Senate amendments to the bill (H.R. 4872) to provide for reconciliation pursuant to Title II of the concurrent resolution on the budget for fiscal year 2010 (S.Con.Res. 13).

Mr. Speaker, each generation has had to take up the question of how to provide for the health of the people of our nation. And each generation has grappled with difficult questions of how to meet the needs of our people. I believe health care is a civil right. Each time as a nation we have reached to expand our basic rights, we have witnessed a slow and painful unfolding of a democratic pageant of striving, of resistance, of breakthroughs, of opposition, of unrelenting efforts and of eventual triumph.

I have spent my life struggling for the rights of working class people and for health care. I grew up understanding first hand what it meant for families who did not get access to needed care. I lived in 21 different places by the time I was 17, including in a couple of cars. I understand the connection between poverty and poor health care, the deeper meaning of what Native Americans have called ``hole in the body, hole in the spirit.'' I struggled with Crohn's disease much of my adult life, to discover sixteen years ago a near-cure in alternative medicine and following a plant-based diet. I have learned with difficulty the benefits of taking charge personally of my own health care. On those few occasions when I have needed it, I have had access to the best allopathic practitioners. As a result I have received the blessings of vitality and high energy. Health and health care is personal for each one of us. As a former surgical technician I know that there are many people who dedicate their lives to helping others improve theirs. I also know their struggles with an insufficient health care system.

There are some who believe that health care is a privilege based on ability to pay. This is the model President Obama is dealing with, attempting to open up health care to another 30 million people, within the context of a system run by insurance companies who make money by denying care. There are others who believe that health care is a basic right and ought to be provided through a not-for-profit plan. This is what I have tirelessly advocated.

I have carried the banner of national health care in two presidential campaigns, in party platform meetings, and as co-author of H.R. 676, Medicare for All. I have worked to expand the health care debate beyond the current unsustainable system, to include a robust public option and my amendment to free the states to pursue single-payer. An early version of the health care bill, while badly flawed, contained these provisions which I believed made the bill worth supporting when it was considered by the Committee on Education and Labor. I voted for it. The provisions were taken out of the bill after it passed the Committee.

I joined with the Congressional Progressive Caucus in saying that I would not support the bill unless it had a strong public option and unless it protected the right of people to pursue single payer at a state level. It did not. I kept my pledge and voted against the bill when it was considered by the full House of Representatives. Since then, I have continued to oppose it while trying to get the provisions back into the bill. Some have speculated that, as the final vote on this health care package drew closer, I might have been in a position of casting the deciding vote. The President's visit to my district on Monday underscored the urgency of this moment.

I have taken this fight further than many in Congress cared to carry it because I know what my constituents experience on a daily basis. Come to my district in Cleveland and you will understand.

The people of Ohio's 10th district have been hard hit by an economy where wealth has accelerated upwards through plant closings, massive unemployment, small business failings, lack of access to credit, foreclosures and the high cost of health care and limited access to care. I take my responsibilities to the people of my district personally. The focus of my district office is constituent service, which more often than not involves social work to help people survive economic perils. It also involves intervening with insurance companies.

In the two weeks before the vote on the final health care package, it became clear that the vote would be very close. I take this vote with the utmost seriousness. I am quite aware of the historic fight that has lasted the better part of the last century to bring America in line with so many other modern democracies in providing single-payer health care. I have seen the political pressure and the financial pressure being asserted to prevent a real challenge to a highly profitable system dominated by private insurance companies.

I know I have to make a decision, not on the bill as I would like to see it, but the bill as

it is. My criticisms of the legislation have been well reported. I do not retract them. I incorporate them in this statement. They still stand as legitimate and cautionary. I still have doubts about the bill. I do not think it is a first step toward anything I have supported in the past. This is not the bill I wanted to support, even as I continue efforts until the last minute to modify the bill.

However after careful discussions with President Obama, Speaker Pelosi, my wife Elizabeth, the frequently personal and tragic stories of my constituents and close friends, I have decided to cast a vote in favor of the legislation. If my vote is to be counted, let it now count for passage of the bill, hopefully in the direction of comprehensive health care reform. We must include coverage for those excluded from this bill. We must free the states. We must have control over private insurance companies and the cost their very existence imposes on American families. We must strive to provide a significant place for alternative and complementary medicine, religious health science practice, and the personal responsibility aspects of health care which include diet, nutrition, and exercise.

The health care debate has been severely hampered by fear, myths, and by hyper-partisanship. The President clearly does not advocate socialism or a government takeover of health care. The fear that this legislation has engendered has deep roots, not in foreign ideology but in a lack of confidence, a timidity, mistrust and fear which post 911 America has been unable to shake.

This fear has so infected our politics, our economics and our international relations that as a nation we are losing sight of the expanded vision, the electrifying potential we caught a glimpse of with the election of Barack Obama. The transformational potential of his presidency, and of ourselves, can still be courageously summoned in ways that will reconnect America to our hopes for expanded opportunities for jobs, housing, education, peace, and yes, health care.

I want to thank those who have supported me personally and politically as I have struggled with this decision. I ask for continued support in our ongoing efforts to bring about meaningful change. I have taken a detour through supporting this bill, but I know the destination I will continue to seek, for as long as it takes, whatever it takes, is an America where health care will be firmly established as a civil right.

Empowering individuals

Smart personal choices in areas like diet, nutrition, and exercise are essential to a healthier world. At the same time, we must remove the barriers and change the incentives that discourage or prevent responsible behavior. The Institute of Medicine estimates that in 2004 approximately $10 billion was spent on food advertising directed at children, using every method available--television, radio, the internet, even embedded in video games. Simply put, marketing to children works--companies would not make such a substantial investment if it were ineffective.

Marketing directed at youth is extremely well constructed and relies heavily on behavioral science. The developing brain of the child can not discriminate fact from opinion and can not think critically; it is no match for a $10 billion industry that exploits this vulnerability using cartoons, cross branding with popular toys, giveaways, and myriad other methods to develop brand loyalty and shape judgment as early as possible. Established early, these affinities are the most enduring.

Astonishingly, the Federal Government subsidizes this methodical preying on children by granting a tax write-off for expenses associated with it. This must stop. The government must take action to protect American children and ensure that they grow up in a healthy environment. My bill, H.R. 4310, would eliminate the tax deductibility of fast food and junk food advertising directed at children. H.R. 4310 has the potential to raise billions of dollars in revenue to fund child nutrition and anti-obesity initiatives.

There is precedent: approximately 50 countries, including Sweden, Norway, Australia, and Great Britain, have limited or prohibited food advertising directed at youth. Additionally, recent research has concluded that eliminating the tax deductibility of food advertising directed at youth would reduce obesity rates. Long-term health care reform must address the personal responsibility, the corporate responsibility, and the government's fair share of the responsibility for improved health. I will work to ensure that is the case.

Each generation has had to take up the question of how to provide for the health of the people of our nation. And each generation has grappled with difficult questions of how to meet the needs of our people. I believe health care is a civil right. Each time as a nation we have reached to expand our basic rights, we have witnessed a slow and painful unfolding of a democratic pageant of striving, of resistance, of breakthroughs, of opposition, of unrelenting efforts and of eventual triumph.

I have spent my life struggling for the rights of working class people and for health care. I grew up understanding first hand what it meant for families who did not get access to needed care. I lived in 21 different places by the time I was 17, including in a couple of cars. I understand the connection between poverty and poor health care, the deeper meaning of what Native Americans have called ``hole in the body, hole in the spirit.'' I struggled with Crohn's disease much of my adult life, to discover sixteen years ago a near-cure in alternative medicine and following a plant-based diet. I have learned with difficulty the benefits of taking charge personally of my own health care. On those few occasions when I have needed it, I have had access to the best allopathic practitioners. As a result I have received the blessings of vitality and high energy. Health and health care is personal for each one of us. As a former surgical technician I know that there are many people who dedicate their lives to helping others improve theirs. I also know their struggles with an insufficient health care system.

There are some who believe that health care is a privilege based on ability to pay. This is the model President Obama is dealing with, attempting to open up health care to another 30 million people, within the context of the for-profit insurance system. There are others who believe that health care is a basic right and ought to be provided through a not-for-profit plan. This is what I have tirelessly advocated.

I have carried the banner of national health care in two presidential campaigns, in party platform meetings, and as co-author of H.R. 676, Medicare for All. I have worked to expand the health care debate beyond the current unsustainable system, to include a robust public option and my amendment to free the states to pursue single-payer. An early version of the health care bill, while badly flawed, contained these provisions which I believed made the bill worth supporting when it was considered by the Committee on Education and Labor. I voted for it. The provisions were taken out of the bill after it passed the Committee.

I joined with the Congressional Progressive Caucus in saying that I would not support the bill unless it had a strong public option and unless it protected the right of people to pursue single payer at a state level. It did not. I kept my pledge and voted against the bill when it was considered by the full House of Representatives. Since then, I have continued to oppose it while trying to get the provisions back into the bill. Some have speculated that, as the final vote on this health care package drew closer, I might have been in a position of casting the deciding vote. The President's visit to my district on Monday underscored the urgency of this moment.

I have taken this fight further than many in Congress cared to carry it because I know what my constituents experience on a daily basis. Come to my district in Cleveland and you will understand.

The people of Ohio's 10th district have been hard hit by an economy where wealth has accelerated upwards through plant closings, massive unemployment, small business failings, lack of access to credit, foreclosures and the high cost of health care and limited access to care. I take my responsibilities to the people of my district personally. The focus of my district office is constituent service, which more often then not involves social work to help people survive economic perils. It also involves intervening with insurance companies.

In the two weeks before the vote on the final health care package, it became clear that the vote would be very close. I take this vote with the utmost seriousness. I am quite aware of the historic fight that has lasted the better part of the last century to bring America in line with so many other modern democracies in providing single-payer health care. I have seen the political pressure and the financial pressure being asserted to prevent a real challenge to a highly profitable system dominated by private insurance companies.

I know I have to make a decision, not on the bill as I would like to see it, but the bill as it is. My criticisms of the legislation have been well reported. I do not retract them. I incorporate them int this statement. They still stand as legitimate and cautionary. I still have doubts about the bill. I do not think it is a first step toward anything I have supported in the past. This is not the bill I wanted to support, even as I continue efforts until the last minute to modify the bill.

However after careful discussions with the President Obama, Speaker Pelosi, my wife Elizabeth, and in consideration of the frequently personal and tragic stories of my constituents, I have decided to cast a vote in favor of the legislation. If my vote is to be counted, let it now count for passage of the bill, hopefully in the direction of comprehensive health care reform. We must include coverage for those excluded from this bill. We must free the states. We must have control over private insurance companies and the cost their very existence imposes on American

families. We must strive to provide a significant place for alternative and complementary medicine, religious health science practice, and the personal responsibility aspects of health care which include diet, nutrition, and exercise.

The health care debate has been severely hampered by fear, myths, and by hyper-partisanship. The President clearly does not advocate socialism or a government takeover of health care. The fear that this legislation has engendered has deep roots, not in foreign ideology but in a lack of confidence, a timidity, mistrust and fear which post 911 America has been unable to shake.

This fear has so infected our politics, our economics and our international relations that as a nation we are losing sight of the expanded vision, the electrifying potential we caught a glimpse of with the election of Barack Obama. The transformational potential of his presidency, and of ourselves, can still be courageously summoned in ways that will reconnect America to our hopes for expanded opportunities for jobs, housing, education, peace, and yes, health care.

I want to thank those who have supported me personally and politically as I have struggled with this decision. I ask for continued support in our ongoing efforts to bring about meaningful change. As this bill passes I will renew my efforts to help those state organizations which are aimed at stirring a single payer movement which eliminates the predatory role of private insurers who make money not providing health care. I have taken a detour through supporting this bill, but I know the destination I will continue to seek, for as long as it takes, whatever it takes, is an America where health care will be firmly established as a civil right.

moving Toward True Health Care Reform

In pursuing meaningful change in the health care system, there can be no better investment than to remove federal barriers to allowing states to implement the only model of health care proven to cover everyone, lower costs and increase quality: single-payer.

Systems that remove the insurance companies from care are well tested and consistently outperform systems that rely on private insurance. Their costs are lower, their access is universal, the coverage is comprehensive, and their systems are far more equitable. Such a single- payer health care system would also provide major economic stimulus. Half of all bankruptcies in the U.S. are the result of the failure of an insurance plan to do the very thing that drives us to buy health insurance--protect us from catastrophic financial burdens that arise from health care needs. Only single-payer health care can rid us of the economic drag of medical bankruptcies by providing truly comprehensive coverage--for less money than we are currently paying.

It is no wonder then that states are demanding single payer. Not only does it help people stay out of poverty, but it would provide major relief for states facing budget difficulties. The Lewin Group's financial analysis of the California single payer bill that recently passed the legislature twice found that ``the net cost of the program to state and local governments is a savings of about $900 million'' in 2006 alone. There are also strong single payer movements in Pennsylvania, New York, Illinois, Colorado, and New Mexico. In fact, the savings to a state from a single-payer plan have been well documented. Fourteen states are listed below, along with their savings and the year of the applicable study. The worst-case scenario is Maine, which would break even.

State: Annual Single-payer Savings--Year

New Mexico (Lewin Group): $151,800,000--1994

Delaware (Solutions for Progress): $229,000,000--1995

Minnesota (Lewin Group): $718,000,000--1995

Massachusetts (Lewin Group, Solutions for Progress/Boston

University School of Public Health): $1,800,000,000--

$3,600,000,000--1998

Maryland (Lewin Group): $345,000,000--2000

Vermont (Lewin Group): $118,000,000--2001

California (Lewin Group): $7,500,000,000--2002

Maine (Mathemetica Policy): $0--2002

Rhode Island (Solutions for Progress/Boston University

School of Public Health): $270,000,000--2002

Missouri (Missouri Foundation for Health): $1,700,000,000--

2003

Georgia (Lewin Group): $716,000,000--2004

California (Lewin Group): $8,000,000,000--2005

Colorado (Lewin Group): $1,400,000,000--2007

Kansas (Lewin Group): $869,000,000--2007

The Employee Retirement Income Security Act (ERISA) has been used to thwart efforts at the state and regional level to improve health care. Though the law was intended to protect the integrity and quality of employee benefit plans including health care, ERISA has been used in courts to stop or make impractical health care reform efforts in Maryland, San Francisco, and Suffolk County, New York. It is the most difficult federal barrier a single-payer state will face, though there will be others.

I will continue to work to help these states. We must yield to the wishes of those in a state who demand a health care system that is proven to work well. It would be entirely voluntary. If a state wants better health care than can be provided by the federal government, the federal government should not stand in their way.

Public Option

A robust public option is not sufficient to control costs, cover everyone, and increase quality of care. However, it is a good interim option for those who do not want to be subject to the abuses of the insurance companies but are required to purchase health insurance under the health care bill we are passing today. The extreme inefficiency of the private health insurance companies and the inefficiency they cause throughout the health care system are well documented. Americans need refuge because the health insurance companies are ruthlessly efficient at one thing: denying care. They have to be because that is how they make money.

In the short term, I will continue to fight for a strong public option until a single payer plan is in place.

Integrative Medicine and Religious Health Care

A 2008 study by the National Center for Complementary and Alternative Medicine at the National Institutes of Health and the National Center for Health Statistics revealed that 38% of American adults used some form of integrative medicine to meet their health care needs. However, access to these services is limited because of lack of insurance coverage of these safe, cost-effective and clinically effective medical approaches. Some of those modalities include chiropractic care, acupuncture and many others under study at the National Institutes of Health.

However, some insurance companies are starting to realize that it is beneficial to their bottom line if they cover some integrative medicine approaches. More and more plans are covering chiropractic and acupuncture, for example. The medical literature abounds with studies showing that the cost-effectiveness of interventions like transcendental meditation for hypertension and heart disease is far better than that for conventional pharmaceutical interventions.

An early version of the health care overhaul bill included my amendment that would guarantee that a practitioner of integrative medicine is one of the people that decides the minimum required benefit package. It also created a task force of integrative medicine practitioners to help inform the decision makers about what should be covered. Finally, it required that when a patient goes to the Exchange website and looks up doctors, practitioners of integrative medicine are easily identifiable. Though the language was removed before a vote on the bill was taken by the full House of Representatives, I will continue to work to advance integrative medicine by increasing its accessibility and safety.

Under this bill, most Americans, including people who practice other distinctive approaches to health care, are forced to buy private health insurance. I recognize the difficult position for Christian Scientists and others similarly situated. Millions opt for spiritual care that coincides with their religion. But as of today, even though the care they prefer is covered by Medicare, Medicaid, TRICARE and some plans available to federal government employees, few private insurance plans cover it. The new healthcare legislation we are considering today does not prevent insurance companies from covering their care; it also does not create a pathway for its serious consideration by insurance companies. I look forward to helping to identify a way to ensure that spiritual and integrative care get a fair chance at coverage by insurance companies.

Madam Speaker, let me first extend my appreciation to my good friend from Rochester, New York, Ms. Slaughter, for yielding me the customary 30 minutes, and I yield myself such time as I may consume.

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

Madam Speaker, last Sunday when we opened debate here on the rule, I opened by condemning the attacks that have been made on Members of this institution, their families and their staffs. Unfortunately, it is something which all of us who have been privileged to serve in elective office and as Members of Congress in particular have had to face for many years. I will reiterate, Madam Speaker, violence or the threat of violence is simply unconscionable, and we all join together in calling for an immediate end to these types of utterly unacceptable acts.

Madam Speaker, last Sunday I also predicted that we would be back here voting once again on the reconciliation bill. And here we are.

The need for another vote is further demonstration of just how flawed the tactics of the Democrats in charge of Congress have been. It shouldn't surprise anyone, Madam Speaker, that the reconciliation bill was found to violate Senate rules, as traditionally has been the case with the only exception in 1983. No legislation of this magnitude can be slapped together at the last minute and then withstand scrutiny. Our revote today is just further evidence of the perils of the refusal of the Democrats in charge to act in a bipartisan and open way.

We have been debating the issue of health care reform in the Congress for a long period of time. As a Nation, we have been struggling with the very serious issue of increasing access to quality care for many, many, many years. We all want to expand coverage and improve quality for the American people. There are a number of key reforms that enjoy broad bipartisan support that would bring us much, much closer to that goal.

Yet, despite these opportunities for bipartisanship, Madam Speaker, the Democrats in charge insisted on forcing through the most partisan and costly bill possible. And despite all the time that has been spent on this issue, they insisted on forcing through a reconciliation bill that was largely written the night before we voted on it. Again, Madam Speaker, this was written in large part the night before we voted on it. That is why it should be no surprise, and there were those of us last Sunday who predicted that we would be back here.

Less than a week after that vote, serious mistakes in the legislative package have already been discovered, as I have said. Today's underlying package, as I said at the outset, has been returned to the House because it contained provisions that violated Senate rules.

Far more significant, however, are the mistakes that have been uncovered relating to a key provision in the Senate health care bill that is now law, mistakes that will not be fixed today; and I underscore, mistakes that will not be fixed today. One of the centerpieces of that legislation was a provision to ensure that no child is denied coverage for a preexisting condition. This is an issue that again enjoys overwhelming bipartisan support. I believe very passionately in the need to ensure that no one is denied coverage for preexisting conditions.

Madam Speaker, had we taken a responsible, step-by-step approach to reform, this provision dealing with preexisting conditions could have been signed into law months ago; but because the Democrats in charge shunned bipartisan cooperation and an open, transparent process, forcing through a hyper-partisan bill with no opportunity for open debate or any amendment, their $1 trillion bill passed Congress without any real accountability.

The result? They botched the language on preexisting conditions and we now know, Madam Speaker, that children will not get the coverage that they were promised. This is the inevitable result of a closed, partisan process.

Even the good ideas that are put out there that both Democrats and Republicans alike can come to an agreement on are undermined by a lack of scrutiny and transparency. Their bill was certainly filled with a lot of terrible ideas. Spending $1 trillion we don't have and hiring tens of thousands of new IRS agents to investigate hardworking Americans ranks at the very top of that list. But even the provisions like preexisting conditions that had bipartisan support are being undermined by shoddy work.

While the legal experts sort out the mess that was made of the legislative language, job creators are assessing just how much damage has been done to them. Today, The Wall Street Journal pointed out that companies large and small are taking stock of the new taxes that have been imposed and what the impact will be.

Now, we had an exchange upstairs about the fact that we have seen the stock market go up, and we all know that the stock market has gone up. But that does not belie the fact that Caterpillar will face $100 million in new taxes in the first year alone. The medical device company Medtronic fears it may have to lay off 1,000 workers in order to pay the new taxes.

Madam Speaker, with the national unemployment rate as we all know hovering just under 10 percent, this could not be a worse time to impose job-killing tax increases. The prospect of crippling new taxes and further job losses is not acceptable. We should focus on creating, not losing, good private sector jobs.

The process of reforming the so-called reform bill and undoing the damage that has been done will take years, wasting untold taxpayer dollars we cannot afford. Wasting precious time while the American people wait for real reform that actually improves access to quality health care is a waste. It shouldn't be done, and this is a tragically missed opportunity.

To the many Americans who are outraged by this bill and the process by which it was considered, and by the way, we are here under what is known as martial law rule. We just completed our meeting in the Rules Committee a few minutes ago, and without any consideration we have come right down to the House floor. People are outraged with this process. That has played a role in creating the anger that is there. I can only say there are still some Members of Congress, and I am one of them, who believe in bipartisan cooperation--in bipartisan cooperation, and we believe, as was promised in a new direction for America that then- Minority Leader Pelosi put forth for the American people and said she

would have when she took the oath in January of 2007, an open, transparent process. To many Americans who had high hopes for a true reform bill, I will say there are still some Members of Congress who will fight for real reform even if the Democrats in charge will not do that.

We will fight to ensure that all Americans have effective guarantees of coverage despite preexisting conditions. We will fight for meaningful lawsuit abuse reform, and we will work to allow small businesses and States to band together to offer better and more affordable coverage.

We will work to ensure that government bureaucrats never come between patients and doctors. We will make sure that no one will be forced to give up their current coverage if they do not so choose, and that those who have diligently saved in their health savings accounts are not in any way punished.

If we can abandon the failed tactics that the Democrats in charge have put forward and work in an bipartisan and open fashion, these are the kind of real reforms that can be enacted so all Americans will have access to quality, affordable health insurance.

I reserve the balance of my time.

Announcement by the Speaker Pro Tempore

Madam Speaker, at this time, I'm happy to yield 2 minutes to a very hardworking new Member who's an expert on TennCare, an obstetrician from Johnson City, Tennessee (Mr. Roe).

Madam Speaker, I yield myself such time as I might consume, and I would like to engage in a discussion, if I might, with my good friend from Johnson City, Tennessee, who, as we say, appears to be the only medical doctor here on the House floor at the moment.

He was just discussing his role and many years he's served, worked as an obstetrician, and one of the things that we have found, reports are--and this is before this bill was even considered--that there are many people who are in a position where they are being told, people who are under Medicare, that they are being refused an opportunity to have the kind of physician choice that they want.

We regularly have heard throughout this debate that you'll be able to choose your own doctor. But, Madam Speaker, I ask the question: Will your doctor choose you? What kind of incentive do we have at this juncture for people to get into the medical profession?

And I'd like to yield, if I might, to my friend from Johnson City, if he might respond to this notion of, well, you may be able to choose your doctor, but will your doctor choose you. And I am happy to yield to my friend.

I thank my friend for his remarks. And let me just say, this notion of you may choose your doctor but your doctor may not choose you, is that a fair assessment?

I'm happy to further yield to my friend.

And that's why I was arguing that it is really difficult to imagine why it is that people will pursue the medical profession, as the gentleman has done so ably over the years.

And I am happy to further yield to my friend.

I thank my friend.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I yield myself such time as I might consume, and I would like to engage in a discussion, if I might, with my friend and argue that I totally concur. We totally concur with the need to work on this issue of preexisting conditions.

The problem, Madam Speaker, has been that while this was extraordinarily well-intentioned, we've already found that this shoddily put together bill has denied the addressing of preexisting conditions. There are people out there who unfortunately believe, Madam Speaker, that the issue of preexisting conditions has been taken care of. One needs to look at the news reports right now of the problems that exist with our shared bipartisan goal of addressing that issue.

I reserve the balance of my time.

May I inquire of the Chair how much time is remaining on each side?

I will reserve the balance of my time, Madam Speaker.

Madam Speaker, at this time I am happy to yield 1\1/2\ minutes to a very hardworking member of the Committee on Rules, the latest recipient of the Ronald Reagan award, our friend from Grandfather Community, North Carolina (Ms. Foxx).

Mr. Speaker, it's nice to see you, but I should say for the record I did enjoy seeing Ms. Edwards in the chair more than I am enjoying seeing you here. But it's always good to see you.

With that, I would like to yield 1\1/2\ minutes to our very hardworking colleague from Bainbridge Township, Ohio (Mr. LaTourette).

I yield my friend an additional 15 seconds.

Mr. Speaker, at this time, I am happy to yield 2 minutes to the gentleman from Ennis, Texas (Mr. Barton), the hardworking ranking minority member on the Committee of Energy and Commerce.

(Mr. BARTON of Texas asked and was given permission to revise and extend his remarks.)

Mr. Speaker, at this time I am happy to yield 1 minute to our hardworking colleague from Indianapolis, Indiana (Mr. Burton).

Mr. Speaker, I yield 1 minute to the gentleman from Athens, Georgia (Mr. Broun), another one of our very able medical doctors.

Mr. Speaker, I yield 1 minute to our friend from Goddard, Kansas (Mr. Tiahrt).

Mr. Speaker, may I inquire of my friend how many speakers she has remaining?

We don't have that many.

I reserve the balance of my time.

Mr. Speaker, at this time I yield 3 minutes to my very good friend, another medical doctor who is with us here, the gentleman from Lewisville, Texas (Mr. Burgess).

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

May I inquire of the distinguished Chair of the Committee on Rules how many speakers she has remaining.

And then you plan to close?

So then no more speakers other than your close. Is that it?

Mr. Speaker, now may I inquire of the distinguished Chair of the Committee on Rules if she has three or four more speakers? I don't know, Mr. Speaker, if the distinguished Chair on the Committee on Rules has anymore speakers.

I just wanted to clarify that.

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

Mr. Speaker, I am going to close the debate as I had begun, by denouncing the charges and smears that we have seen over the past several weeks. Tragically, those of us who serve as Members of Congress for years have dealt with that. It is unacceptable and outrageous, and we all join together in decrying the things that we have seen.

Mr. Speaker, there is a high level of frustration over the process through which we have gone, and there is an understandable outrage from people all across this country for the final work product that we have.

The process has been, at very best--I am trying to be generous-- unorthodox. The notion of utilizing reconciliation, which is designed to reconcile budget discrepancies, for this, is not the right thing to do. And it has never, ever, since passage of the 1974 Budget Entitlement Act, been used for such a monumental piece of legislation.

We have tried desperately to work in a bipartisan way, and everyone talks about this. But, Mr. Speaker, we have reached out, as Mr. Burgess said, time and time again, and we have been rebuffed. The only thing bipartisan about this legislation and the vote that we will see tonight, Mr. Speaker, is not the support for it but the opposition to it.

Our colleagues on the other side of the aisle have a 70-seat majority, and yet many of their Members will be joining us, as they did last Sunday night, in opposing this. Why? Because they know that this is badly flawed legislation. It's badly flawed legislation, because, as we listened to so many medical doctors point out, we are told that you can choose your own doctor. We constantly hear that refrain from the President and others. But the question is, With the decrease in the numbers of doctors out there, will your doctor choose you?

And then, Mr. Speaker, we get to the question of, Will we or will we not be able to pay for this? Well, $1 trillion, 569.2 billion in tax increases, and tremendous uncertainty is not going to adequately address the challenges that we have.

We all want to ensure that no one is denied access to health care because of preexisting conditions. We can do that in a bipartisan way. But, Mr. Speaker, unfortunately, this bill doesn't do that.

There are people out there who today believe that they will not be denied access to insurance because of preexisting conditions. But, guess what? Because this bill was so poorly put together, right now they are denied access. We want to make sure, and we are happy to work in a bipartisan way, to address that concern.

As we look at the fact that we are back here tonight because of those two amendments that were problems in the Senate, the fact that we already have announced problems with the goal of ensuring that everyone has access, is not denied access because of preexisting conditions, and when we look at the challenges that have been put forward time and time again, we simply ask our colleagues: When we work to clean this up, Mr. Speaker, I hope very much we will be able to work in a bipartisan way.

I urge a ``no'' vote.

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

Madam Speaker, by direction of the Committee on Rules, I call up House Resolution 1225 and ask for its immediate consideration.

Madam Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentleman from California (Mr. Dreier). All time yielded during consideration of the rule is for debate only.

General Leave

I ask unanimous consent that all Members have 5 legislative days within which to revise and extend their remarks and insert extraneous materials into the Record.

I yield myself such time as I may consume.

Madam Speaker, the rule provides for consideration of the Senate amendments to H.R. 4872. It shall be in order to take from the Speaker's table H.R. 4872, with the Senate amendments thereto, and to consider in the House, without intervention of any point of order except those arising under clause 10 of rule XXI, a single motion offered by the Chair of the Education Committee that the House concur in the Senate amendments. The Senate amendments and the motion shall be considered as read. The rule provides 10 minutes of debate equally divided and controlled by the Chair and the ranking minority member of the Committee on Education and Labor. Finally, the previous question shall be considered as ordered on the motion to final adoption without intervening motion or demand for division of the question.

Madam Speaker, the disturbing atmosphere that we've seen around the Capitol recently is alarming. The rash of ominous threats, voice mails, letters, brick throwing, and other sordid acts of protests is downright despicable and marks a low point in the Nation's history. I say this in part from firsthand experience. As many of you know, my Niagara Falls office was the target of attack last week when someone hurled a brick through the window in the dark of night. Separately, I received a phone call on my campaign office phone line that referenced 16 sniper teams and an attempt that would be made to target the children of Members of Congress who voted for the health care legislation.

Each day my four offices give me a careful log of phone calls and emails from people who have taken the time to share their opinions with me, and I read each of those comments because I value that input and want to hear from everyone, not just the people who agree with me. I daresay there isn't a single elected official in the country who has not had a heated run-in with someone who felt strongly that they had voted the wrong way on an issue. In fact, it is part of this country's great tradition that we not only tolerate dissent but we encourage it.

To speak up and to take part in democracy is a noble and treasured part of the American way. But all that changed last year when suddenly town hall meetings across the country turned into vicious shouting matches. Persons who had taken the time to go to the town meeting to learn about the health care bill were oftentimes harassed and frightened and unable to learn anything except that they felt somewhat under siege. I remember that someone arrived at a meeting with a handgun holstered to his leg, and he could not have been more than 50 yards away from the President of the United States.

Spirited debate has become negative. All of us have noticed that in our offices. As I mentioned, I have four offices. The calls that came in--I thank my staff, and I'm sure all of you do, too, for simply tolerating it. It was all day. One day the calls came in so quickly that not another piece of work could be done in all my offices. We were threatened. We were cajoled. We were told--mostly by people from Texas and Oklahoma--that they would never vote for me again, which would be very unlikely in New York anyway.

But I am happy to tell you that as of Sunday night and the passage of this bill, all of those calls are gone. We were getting up to--I would say totaling in the four offices nearly 100 a day. It's all gone now, and the people who call express sorrow for the trouble that has been put upon me, saying that their America does not do that to anyone, particularly someone that they have put their trust in.

But this week, the leader of the national Republican Party said that Speaker Pelosi should be put ``on the firing line.'' Another Republican leader and former national party candidate placed rifle site targets on a national map showing congressional districts of Democrats who supported health care for all Americans, and that same leader urged her supporters, ``Don't retreat, reload.'' And even worse were the remarks made here by the minority leader, who recently said that one of my colleagues who backed the legislation was politically a ``dead man'' back home. Taken together with the incidents around the country, these episodes might prompt a quick and forceful repudiation of comments that would endorse violence, but instead, we get just the opposite.

When Republican Members went out onto the balcony off the Speaker's lobby Sunday to shout to and encourage rowdy protesters, they were implicitly encouraging a discourse that had already soured. In fact, I was dismayed to learn--not dismayed, dismayed doesn't cover it--I was angry. I was concerned. It terrified me, the thought that we would have to live through any of that again. When I found out that some of my colleagues were the victims of racial epithets, spitting, homophobic slurs, this sort of display is shocking even to someone who has seen some pretty terrible things over the years.

Despite all this, Democrats move forward with hope and optimism. It is my sense that as more Americans learn about the provisions of the health care reform legislation, they will in increasing numbers support the vote over the weekend, and the polls show this already happening.

It is a surprise to me today that with the passage of reconciliation by a 56-43 margin in the Senate, that the other side would continue to try to throw up petty roadblocks or complain that they haven't had time to read the bill.

Do you want to know what we are debating here today? We are debating two sentences. That's it, two sentences. Does it make sense to anyone that the other side is demonizing a bill that has already been approved by both the House and Senate and signed into law? No, instead we should celebrate the incredible accomplishment of finally passing this legislation after a struggle of more than a hundred years.

I won't even bother reciting all of the ways in which ordinary Americans will gain as we shift the balance of power away from insurance companies and back to patients, because they will know very shortly. I have already spoken at length about how under our bill families will no longer feel trapped by their coverage or fearful about children with preexisting conditions. Health care reform, I am happy to say, is now the law of the land. I encourage my colleagues to join me today in quickly adopting these small technical fixes to the legislation so we may move on to more pressing challenges.

I reserve the balance of my time.

Parliamentary Inquiry

Madam Speaker, I yield 3 minutes to the gentleman from Massachusetts (Mr. McGovern), a member of the Rules Committee.

Madam Speaker, I am pleased to yield 2 minutes to the gentlewoman from California (Ms. Matsui), a member of the Rules Committee.

Madam Speaker, I feel I need to introduce Dr. Donna Christensen, who is a medical doctor from the Virgin Islands, for 15 seconds.

Madam Speaker, I yield 2 minutes to the gentleman from Colorado (Mr. Perlmutter), a member of the Rules Committee.

Madam Speaker, I yield 2 minutes to the gentleman from California (Mr. Stark).

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

I yield 2 minutes to the gentleman from New Jersey (Mr. Pallone).

Mr. Speaker, I yield 3 minutes to the gentleman from California (Mr. Waxman).

I cannot yield for that purpose.

I cannot.

I am happy to yield 3 minutes to the gentleman from South Carolina (Mr. Spratt).

I yield 1 minute to the gentleman from New York (Mr. Bishop).

Mr. Speaker, I yield 1 minute to the gentleman from Connecticut (Mr. Courtney).

Mr. Speaker, I yield 1 minute to the gentleman from New York (Mr. Hall).

Mr. Speaker, may I inquire as to the time remaining?

Yes, I have three.

Mr. Speaker, I yield 1 minute to the gentleman from Texas (Mr. Hinojosa).

Mr. Speaker, I yield 1 minute to the gentlewoman from Texas (Ms. Jackson Lee).

I have one more speaker.

As soon as you have.

I have one more speaker, then I hope that you will close and then I will close.

I am pleased to yield 2 minutes to the gentleman from New Jersey (Mr. Andrews).

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

I did misspeak. Mr. Rangel has come in, and I would like to give him 1\1/2\ minutes.

Let me yield 1 minute to Mr. Rangel, the gentleman from New York.

I have no further speakers.

Mr. Speaker, let me just remind us that we have been all this time debating about three lines in the bill. If you want to take the nastiness out of the Senate bill, this is the bill you have to vote for.

I ask a ``yes'' vote from all my colleagues on both the previous question and on the rule.

I move the previous question and the resolution.

The previous question was ordered.

Mr. Speaker, earlier this week history was made with the enactment into law of the comprehensive access to quality affordable health insurance for all Americans. Tonight we complete action on this legislation and cement for all Americans their sense of security that they will always be able to afford and access health care for themselves and their families.

Since our passage of the underlying legislation last weekend, the American people are beginning to fully appreciate the benefits that we have written into law. When fully implemented, reform will bring 32 million uninsured Americans into the health insurance system, seniors will see immediate help with the cost of their prescription drugs, and people who have preexisting medical conditions will not be denied health insurance or charged more for that insurance. If you lose your job, you will not lose access to health care.

Our vote tonight improves on what President Obama signed into law on Tuesday. This includes closing the gap in Medicare prescription drug coverage, including the rebate this year to eligible seniors; improving affordability for those with income up to 400 percent of the poverty level; eliminating the special Medicaid deal for Nebraska; and increasing matching rates to States for the costs of services to newly eligible individuals to 100 percent for the first 3 years of coverage expansions.

Increasing Medicaid payments. The rates will be increased for primary care physicians so that new Medicaid beneficiaries will have access to primary

care and a greater investment into community health centers. These initiatives are fully funded and paid for.

The reconciliation bill reduces the deficit by more than $1 trillion over the next two decades.

Health security is a fundamental right for every American, and we remain faithfully committed to that objective.

I want to use my time here to give special thanks to our health team on our staff. First of all I want to single out Karen Nelsen, who has been director of the health staff going back to the time I was chairman of the Health and Environment Subcommittee and during the time we were over at the Oversight and Government Reform Committee. With her able assistance, we have Jack Ebeler, Tim Gronniger, Andy Schneider, Purvee Kempf, Brian Cohen, Ruth Katz, Anne Morris, Tim Westmoreland, Stephen Cha, Virgil Miller, Katie Campbell, Bobbie Clark, Sarah Dupres and Naomi Seiler.

I want to just close by saying I wish the Republicans would have worked with us instead of fighting this bill every step of the way. They're complaining now they didn't get amendments, but when we called on them to help us, they said no. They wouldn't work with us on the stimulus bill, they wouldn't work with us on the energy bill, they wouldn't work with us on the health bill, but we got it done anyway.

Mr. Speaker, the bill is to be commended as a model of cooperative federalism. Under the new law, ``a State is free to establish a health insurance exchange if it so chooses. But if it declines, the Secretary will establish an exchange.'' This is a strong example of what the Supreme Court has recognized as an appropriate exercise of federal power to encourage State participation in important federal programs. ``[W]here Congress has the authority to regulate private activity under the Commerce Clause, we have recognized Congress' power to offer States the choice of regulating that activity according to federal standards or having state law pre-empted by federal regulation. Hodel v. Virginia Surface Mining & Reclamation Assn., Inc., supra, 452 U.S., at 288, 101 S.Ct., at 2366. See also FERC v. Mississippi, supra, 456 U.S., at 764- 765, 102 S.Ct., at 2140. This arrangement, which has been termed ``a program of cooperative federalism,'' Hodel, supra, 452 U.S., at 289, 101 S.Ct., at 2366, is replicated in numerous federal statutory schemes.'' New York v. United States, 505 U.S. 144, 165 (1992).

Individual Responsibility

The individual responsibility requirement requires individuals to pay a tax on their individual tax filings or provide information documenting they fulfill the requirements for having essential minimum coverage over the past year. Congress makes the following findings to support this requirement, these are in addition to those made on Sunday, March 21, 2010:

(1) The requirement is necessary to achieve near-universal coverage while maintaining the current private-public system. It builds upon and strengthens private employer-based health insurance, which covers 176,000,000 Americans nationwide. In Massachusetts, a similar requirement has strengthened employer-based coverage: despite the economic downturn, the number of workers offered employer-based coverage has actually increased. Sharon K. Long and Karen Stockley, Massachusetts Health Reform: Employer Coverage from Employees' Perspective, Health Affairs, October 1, 2009.

(2) Under the Patient Protection and Affordable Care Act, if there were no requirement, many individuals would wait to purchase health insurance until they needed care. Those individuals would then get the benefit of the lower premiums that are a direct result of the Act's reforms, even though those lower premiums result in part from the fact that other younger and healthier people bought insurance at an earlier point. Higher-risk individuals would be more likely to enroll in coverage, increasing premiums and costs to the government. The Urban Institute, January 2008. The requirement will broaden the private health insurance risk pool to include healthy individuals, which will spread risk, stabilize the market, and lower premiums. Congressional Budget Office, An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act, November 30, 2009. It is necessary to create effective private health insurance markets throughout the country in which improved health insurance products that are guaranteed issue and do not exclude coverage of pre-existing conditions can be sold.

(3) Administrative costs for private health insurance, which were $90,000,000,000 in 2006, are 26 to 30 percent of premiums in the current individual and small group markets. Congressional Budget Office, December 2008. The requirement is necessary to create effective private health insurance markets throughout the country that do not require underwriting, eliminating its associated administrative costs. By significantly increasing health insurance coverage and the size of purchasing pools, which will increase economies of scale, the requirement, together with the other provisions of the Patient Protection and Affordable Care Act, will significantly reduce administrative costs and lower health insurance premiums.

(4) Health insurance and health care services are a substantial part of the national economy. National health spending is projected to increase from $2,500,000,000,000, or 17.6 percent of the economy, in 2009 to $4,700,000,000,000 in 2019. Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Expenditure Projections, 2008-2018. Private health insurance spending is projected to be $854,000,000,000 in 2009, and pays for medical supplies, drugs, and equipment that are shipped in interstate commerce. Centers for Medicare & Medicaid Services, Office of the Actuary. Since most health insurance is sold by national or regional health insurance companies, health insurance is sold in interstate commerce and claims payments flow through interstate commerce.

(5) The requirement, together with the other provisions of the Patient Protection and Affordable Care Act, will add more than 30,000,000 consumers to the health insurance market. Congressional Budget Office, Patient Protection and Affordable Care Act, Incorporating the Manager's Amendment, December 19, 2009. In doing so, it will increase the demand for, and the supply of, health care services. According to one estimate, the use of health care by the currently uninsured could increase by 25 to 60 percent. Congressional Budget Office, December 2008.

(6) Under the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Patient Protection and Affordable Care Act, the Federal Government has a significant role in regulating health insurance. The requirement is an essential part of this larger regulation of economic activity, and the absence of the requirement would undercut Federal regulation of the health insurance market.

(7) Payments collected from individuals who fail to maintain minimum essential coverage will contribute revenue that will help the Federal government finance a reformed health insurance system that ensures the availability of health insurance to all Americans.

The preceding 7 points cite numerous studies and papers which illustrate the extensive evidence that the Patient Protection and Affordable Care Act, as amended by Section 1002 of the Health Care and Education Reconciliation Act, substantially affects interstate commerce. These citations are included as hyperlinks or in their written entirety for the record.

Mr. Speaker, this week, I had the honor and privilege of joining my Democratic colleagues at the White House, to witness President Barack Obama sign into law, the Patient Protection and Affordable Care Act (H.R. 3590)--the most significant piece of health care legislation since the enactment of Medicare in 1965.

This legislation fulfills one of the most basic tenets of the Declaration of Independence--the provision of our natural unalienable rights of life, liberty and the pursuit of happiness. H.R. 3590 secures these rights for every American by ensuring them access to quality, affordable healthcare.

While waiting for President Obama to sign the legislation, I thought about the thousands of families and friends who have lost loved ones because they lacked access to basic health care coverage.

I also thought about the generations of activists and policy makers who fought to make this monumental achievement a reality.

I have always been proud to be a Member of Congress but voting in favor H.R. 3590 and being present at the signing ceremony was by far my proudest moment.

By signing this legislation into law, President Obama ensured that the United States remains a leader among industrialized nations, and that the American people can now take comfort in knowing that an illness will no longer wipeout their life savings and lead to bankruptcy.

Although the idea of providing people with access to quality, affordable health care has been around since the early 1900s, it was the Democratic-led 111th Congress that made the historic statement that healthcare is in fact a right, not a privilege.

We affirmed to millions of Americans that we are aware of their struggles and that we are willing to fight for them and do what is morally and fundamentally right.

During the November 2008 election, Americans overwhelmingly voted for change.

They demanded a government willing to stand up to big business, and that is transparent in its actions.

But above all else, people demanded a government that is willing to be responsive to their needs--and we affirmed their trust in us by passing this legislation.

Is the legislation perfect? No!

I still favor a single payer system and I was a strong supporter of the public option.

That being said, H.R. 3590 is 100 percent better than what was previously available in this nation.

Prior to the enactment of this legislation:

Over 47 million Americans were uninsured. In 2008, 23 million uninsured were employed adults and 7.3 million were children;

Nearly 41 thousand people died each year because they lacked access to quality, affordable healthcare insurance; and

Every minute, 8 people were denied coverage, charged a higher rate, or otherwise discriminated against because of a pre-existing condition.

If Congress had not successfully passed this legislation:

Employers would be unable to afford rising health care costs, and an additional 3.5 million people would be unemployed and without benefits in the next 4 years.

Small businesses would lose $52.1 billion in profits to high health care costs over the next ten years; and

By 2019, national health care expenditures would reach $4.5 trillion--more than double 2007 spending.

The American people have waited for over 100 years for this legislation and this is what they will get immediately:

We provide tax credits to small businesses to make employee coverage more affordable;

$250 will be provided to Medicare beneficiaries who hit the ``donut hole'' in 2010;

Within 90 days, Americans who are uninsured because of a pre-existing condition will be able to obtain insurance through a temporary high- risk pool;

Within 6 months, insurance companies will be prohibited from denying coverage to children with pre-existing conditions;

Health plans will be required to allow young people up to their 26th birthday to remain on their parents' insurance policy;

Health plans will be prohibited from dropping people from coverage when they get sick;

Health plans will be prohibited from placing lifetime caps on coverage; and

Beginning January 2011, preventive services under Medicare will be free.

To put it simply, Congress met its moral obligation in passing healthcare reform. With our historic vote, we told future generations that no American will suffer and die because of a lack of insurance.

We told insurance companies that, while they are a valuable part of our nation, they will be held accountable for delivering on their promises.

We told our elderly that our commitment to them remains strong, and that the programs they have come to trust will continue to be deserving of that trust.

The reform we passed will help millions of Americans.

In addition to providing access to health care coverage, H.R. 3590 goes far in addressing health care disparities in our nation's minority communities.

Specifically, it includes language that I introduced with Representative Jesse Jackson, Jr., (D-Ill.) H.R. 2778, the Health Equity and Accountability Through Research Act.

This legislation sought to elevate the National Center on Minority Health and Health Disparities (NCMHD) to the level of Institute, giving it the authority to better address the appalling health disparities that are plaguing our nation's minority communities.

NCMHD was created to promote minority health and to lead, coordinate, and assess the efforts of the National Institutes of Health (NIH) in reducing and to ultimately eliminate health disparities.

Unfortunately, the previous structure of NCMHD created confusion regarding who has the responsibility for the coordinated minority health disparities research conducted or supported by NIH.

Additionally, NCMHD lacked real input into and authority over all NIH-supported health disparities activities and funds.

H.R. 3590 addressed these concerns by elevating the Center to the level of Institute, and clarifies the role of the Director as coordinator and manager of the NIH-wide minority health and health disparities portfolio.

The bill also provides the new Institute with professional judgment over NIH-wide minority health and health disparities budgets as well as management over NIH-wide minority health and health disparities allocations.

However, this is not the only improvement that minority and underserved communities will see.

This comprehensive healthcare package also includes $11 billion for community health centers, which offer comprehensive primary care and mental health services to underserved populations. These health centers are a critical stopgap, allowing better care for chronic conditions, while preventing unnecessary trips to the emergency room.

Last but certainly not least, H.R. 3590 honors the life of Deamonte Driver--a 12-year-old boy from Maryland whose life was cut drastically short three years ago when an untreated tooth infection spread to his brain.

Deamonte's tragic death haunts me to this day. Eighty dollars worth of dental care might have saved his life, but he never got that care because he lacked access to a dentist.

The health care bill that we passed will prevent others from dying in such a tragic fashion. Under the new law:

Pediatric dentistry is covered as an essential health benefit;

Funds will be provided to launch a dental campaign to new parents and traditionally underserved areas;

Workforce Training Grants will be available to provide technical assistance to pediatric training programs in developing and implementing instruction regarding the oral health status, dental care needs, and risk-based clinical disease management of all pediatric populations with an emphasis on underserved children; and

H.R. 3590 also includes a loan repayment program with preference given to qualified applicants who have a record of training individuals who are from a rural or disadvantaged background.

However, minorities and underserved communities will not be the only populations that will benefit from our actions. Millions will be touched by healthcare reform in their daily lives in marked, measurable ways.

Thirty-one million Americans will have the opportunity to protect themselves from the fear that a small injury could lead to bankruptcy; and

147,000 families and 14,000 small businesses in my District will receive tax credits to help cover their employees with health insurance; and 56,000 young people in my District will be able to get insurance, at fair prices, through policies currently owned by their parents.

To quote the great poet Virgil, ``The greatest wealth is health.''

By passing and signing this legislation, Congress and President Obama have provided the citizens of this nation with immeasurable wealth, comfort and security.

We have firmly put the power back into the hands of the people, and this is an experience that I will cherish long after I leave Congress.