To repeal mandatory funding for school-based health center construction.

Mr. Speaker, what we are going to do here for the next hour is talk about why we feel so strongly the need to repeal, and if not successful, to defund so many provisions of the Patient Protection and Affordable Care Act.

But, Mr. Speaker, before I get started in the subject at hand, I do want to join my colleagues, particularly my colleagues on the Democratic side of the aisle, in remembering our colleague John Adler. I didn't realize that John had been sick. I didn't realize that John had had surgery. I didn't realize until just moments ago that our colleague from New Jersey had died. As I sat here listening to the New Jersey delegation on both sides of the aisle talk about John, it helped me understand a little bit better about him.

All I know about John is that he was a great guy and a really, really nice Member of this body and someone that I respected. I got to know him, Mr. Speaker, in the House gym at 6 o'clock in the morning usually. He would be working out, and I would be working out--I am 15 years older than John was--and we just struck up a good friendship. I truly will miss him, as well as my other colleagues, as they express their sympathy to his wife and his four sons. But truly a great Member.

It reminds me too, Mr. Speaker, that as we do our work, as we do our work with 1-minutes, and we do our work with 5-minute Special Orders, and now this leadership hour talking about a very important issue that our colleagues on the other side of the aisle for the most part, almost 100 percent of them feel very differently about this issue, we differ on a lot of things, and we will continue to do that. It has gone on forever.

But the point I would like to make, and I will conclude with this, is that there are 435 people in this House of Representatives. And sometimes we Republicans are in the majority and sometimes the Democrats are in the majority, and the worm turns, and nothing is forever.

But we have good, decent men and women serving here representing their districts and doing the work of the people. And God bless them. God bless each and every one of them. God bless a Member like John Adler, who died much too young, as my colleagues have said already.

But we want to always keep in mind that as we argue and debate and make points and feel very strongly about an issue, that doesn't mean we don't love one another. And we do. And I loved John Adler. He was a great Member of this body.

Mr. Speaker, again here we are, though, getting right back into the business at hand. And this is a hugely important week, a hugely important week as we try to come to some conclusion in regard to how much money we need to cut out of, not this fiscal year we are in right now, but the last fiscal year, which started--well, actually we are in the fiscal year, but it started on October 1 of 2010.

Here we are, what is it, the 4th of April, 2011, so half of the fiscal year has already expired and we have not funded the government except in this piecemeal fashion.

We didn't have a budget, we didn't have spending bills, and we put these little 2-week Band-Aids, 2, 3 weeks, a little bit of cutting, but from my perspective and from my side of the aisle and our leadership not nearly, nearly enough. And we are faced with this tremendous issue of trying to reach a compromise and an agreement to lower spending.

The American people certainly gave a mandate, I think, to 87 new Republicans and 9 new Democrats to come up here and quit all this spending. Let's not have $1.5 trillion deficits year after year after year. That's how you get to $14 trillion worth of debt, and that's what we are facing right now; and, indeed, in a month or so, we are going to be asked to even raise that debt ceiling statutorily to say, well, we will continue to borrow and kick the can down the road.

Obviously, Mr. Speaker, these are times that try men and women's souls, and we all feel very strongly about our position. But I know my leadership and Members on this side of the aisle, and I hope our Democrat colleagues, feel the same way. We hope and pray that we can do the people's work and cut this spending and get this country back on a sound fiscal footing so that as we go forward to the 2012 budget, which we will hear about tomorrow, that we will continue to work hard to finally balance this budget and get our country out of this significant debt.

Speaking of debt, Mr. Speaker, the reason I am here tonight, I represent the caucus on the Republican side of the aisle known as the House GOP Doctors Caucus. There are, I think, 21 of us now, doctors and nurses on this side of the aisle, with just years and years of clinical experience.

As an example, I spent 26 years practicing my specialty of obstetrics and gynecology. We have registered nurses that are part of the Doctors Caucus. We have specialists, general surgeons, cardiothoracic surgeons, family practitioners, gastroenterologists. I could go on and on, but some of them, hopefully, will be with me during this hour, will join me in a few minutes to talk a little bit more about our concerns, their concerns, Mr. Speaker, with the Patient Protection and Affordable Care Act of 2010.

This was a bill, a law, that was finally passed and signed by President Obama on March 23, 2010, after about a year and a half of debating the issue in both this Chamber and in the Senate Chamber; and when it finally came down to the reality that there weren't enough votes on the Senate side, it was passed by something called reconciliation which, to this day, I don't think the American people understand. But, Mr. Speaker, I will tell you this, what they do understand is they don't like it, they didn't like the process, and they don't like the policy.

Now, I have heard the President say, and I have heard the Democratic leadership in the 111th Congress, when this bill was passed, talk about how Congress and particularly the Democratic Members have been trying to pass a comprehensive massive health care reform law for almost 100 years. They talked about Franklin Delano Roosevelt, and they talked about John Fitzgerald Kennedy and they talked about, of course, President Bill Clinton and saying, you know, we finally got there, we finally did it, we finally accomplished what we were trying to do for almost 100 years.

Well, they missed the point, Mr. Speaker, because the reason why that type of legislation was not passed in 100 years is because the American people back then didn't want it anymore than they do today; and some 62 percent still say, very loudly and very clearly, in poll after poll after poll, we don't want the Federal Government taking over health care, one-sixth of our economy, lock, stock and barrel. We don't want that.

We want improvement in our health care; and no matter how good something might be, there is always room for improvement and, clearly, our health care system is too expensive. We agree with that. I think Members on both sides of the aisle can reach that conclusion pretty clearly.

So there is agreement to try to do everything we can to continue to provide the best health care in the world. It's not true when people say our health care system is like that of a Third World country. Nothing could be further from the truth. We have the greatest health care system in the world, and some of the doctors in the House GOP caucus will be with me tonight to talk about that.

You know the old expression, don't throw the baby out with the bath water, I think that's what we have tended to do here. We have enacted into law--on March 23 of last year, it's already had its 1-year anniversary a couple of weeks ago--we have done something that I think is not only opposed to what the American people want, you should never do that, but it's bad, it's bad medicine.

It's bad for consumers, it's bad for patients, it's certainly bad for corporate America. And it's absolutely bad for the taxpayer. It's a top-down sort of system where a bureaucracy comes between literally and figuratively a doctor and his or her patient. That's not a prescription for improving our health care system.

I have got a couple of posters here with me, and I wanted to reference these to my colleagues. In fact, I will have several more, but I am going to keep this one up on my far left, that one that shows the picture, I forget what his name is. Maybe one of my colleagues will remember.

Well, I remember Boss Hogg, but I was trying to remember what the actor's name is; I don't think he is still living. But I think most of my colleagues do remember Boss Hogg from that old series ``The Dukes of Hazzard.'' It was one of my favorites, kind of like poking fun at ourselves, really; sort of like Archie Bunker and ``All in the Family'' and things like that that those of us who have been around awhile can look back on and laugh and get a chuckle out of it.

But Boss Hogg sort of represents the boss, the bureaucracy, if you will, of the government, Big Government, running health care. Under old Boss Hogg's picture, there he is with that cigar in his hand: you can have whatever you like as long as the boss approves it.

And that's really the way it has turned out, what we talked about in the House. I think it was H.R., House of Representatives, bill No. 3200. It was Senate bill 3590 or H.R. 3590, a shell bill that came over from the Senate and finally was passed into law and became known as the Patient Protection and Affordable Care Act.

But that law has so much bureaucracy, and I will get into some of the numbers on that in regard to all of the new folks in the government that would control health care, but all under this giant government takeover, and Boss Hogg sort of represents that to me as a way of communicating with the public.

But in any regard, before I continue with some of the statistics on the bill, I see that I am joined by my colleague from Georgia, a fellow physician and a member of the House GOP Doctors Caucus, who is a family practice physician from the Athens area where the great University of Georgia is located. Dr. Paul Broun is actually a doctor who makes house calls, which is really unique and refreshing. He has been a welcome addition to not only our Georgia delegation but this body.

I yield to the gentleman from Athens and Augusta and my hometown, Dr. Paul Broun.

Mr. Speaker, I thank the gentleman for his contribution and for being with us this evening. I realize there are conflicting things going on on Capitol Hill this

evening, very important things. But I really appreciate Dr. Broun being with us.

We have also been joined by another member of the Doctors Caucus, that is our good friend and new Member, freshman Member from the great, great State of New York, where my daughter and son-in-law reside. Ann Marie Buerkle is a registered nurse, Mr. Speaker, by profession and certainly knows of what she speaks in regard to health care, representing the Angels of Mercy, if you will.

She is concerned, Mr. Speaker, about the health insurance industry and the complexity of such, and maybe even wants to discuss some ways that we could change and improve, certainly improvement is called for, and it doesn't have to be within a 2,400-page bill, as Dr. Broun was mentioning ObamaCare entails.

So at this time, I'm proud to yield to Representative Ann Marie Buerkle.

Mr. Speaker, I thank the gentlewoman from New York for sharing her thoughts. Certainly, I agree completely with her. She clearly knows of what she speaks.

This law, it is no longer a bill, it is now the law. Patient Protection Affordable Care Act, it has been the law for a little more than a year, as I said earlier. Of course, the Congressional Budget Office that estimates the cost of laws that we put into effect, they give us an estimate when it is in the bill form so Members can decide whether or not what we are about to do is something that is affordable. And the estimate of this law costing $900 billion, Mr. Speaker, the true cost over the next 20 years is probably in the neighborhood of $3 trillion, not $900 billion.

But I do want to just talk about that number and remind my colleagues

about the pay-for provision that the Democratic Party, the former majority party in the 111th Congress, had in place at the time this bill was passed. Everything had to be paid for, so you had to figure out a way to come up with the money.

In passing this bill and paying for it, Mr. Speaker, some $570 billion was taken out of the current Medicare program. The Medicare program, which serves something like 47 million of our seniors, 5 or 6 million of them are younger people who are on disability that are covered under Medicare. And we literally, to help pay for this new entitlement, this new entitlement which has very little to do with Medicare except that half of the money, half of the pay-for in this $900 billion was taken from a program, Medicare, servicing our disabled and our elderly, providing them health care, half of the money was taken out of that system. The actuaries and the Medicare trustees tell us that over the next 75 years, the unfunded liability, Mr. Speaker, of Medicare is something like $35 trillion, with a ``t,'' $35 trillion. And yet we took the money by cutting Medicare Advantage something like $120 billion. We cut money out of hospice. We cut money out of long- term care, skilled nursing homes.

We cut money out of home health care. We taxed everything that even looked like it had anything to do with health care: durable medical equipment, supplying oxygen for people who were and are continuing to struggle from chronic obstructive pulmonary disease. ``Emphysema'' is a term we use a lot, and I think most people would recognize that.

Finally, we came up and said, okay, we've paid for this; but at the same time, Mr. Speaker, we did absolutely nothing in regard to medical liability reform, something that probably if we enacted it--and if there were something in this bill, ObamaCare, as the President did promise that there would be--could save $200 billion a year, according to the RAND Corporation and other think tanks, from the overall cost of health care, which is one-sixth of our entire economy, of our gross domestic product in a year. That's how big this industry is. So there is essentially nothing in the bill about medical liability reform.

Why do I say that, Mr. Speaker?

My colleagues, I think you understand that it's not about the high insurance premiums that doctors have to pay on an annual basis so that they can practice and be protected from liability if something goes wrong. Obviously, they need that protection and those health insurance premiums for the high-risk specialties like the one that I enjoyed for 26 years, OB/GYN, and neurosurgery.

Mr. Speaker, think about that doctor at the Tucson Medical Center who was there in that emergency room when our colleague, Representative Gabrielle Giffords, was taken there literally near death. I think Dr. Rhee was his name, R-H-E-E. In fact, Dr. Rhee, I learned later, was a graduate of the great school that I went to, Georgia Tech, the Georgia Institute of Technology. Dr. Rhee spent his career in the military after completing medical school. He served his country for something like 22, 23 years, and he happened to be in that emergency room as head of the trauma center and had had all that specialty training and all those years of treating our wounded warriors in many conflicts--I'm sure in Afghanistan and Iraq.

If he had not been there for our colleague Gabrielle Giffords--God bless her--we would be talking about her today as we were talking earlier about John Adler, our former colleague from the great State of New Jersey who died today. But that doctor was there. He was there.

I fear, as I talk about this new health care law, there is hardly any provision in there that would provide for doctors, even for primary care physicians. There is some attempt, but when you take all the additional Medicaid-eligible patients, increasing the minimum eligibility at 138 percent of the Federal poverty level, you add just millions of additional patients to be seen and literally hundreds of billions of dollars of additional cost onto the backs of our States that have to have balanced budgets, unlike here in the Federal Government where we just keep borrowing money and where we're now up to $14 trillion worth of debt.

So we have a huge problem in regard to this law that the CBO says costs $900 billion over 10 years. I say--and this poster points it out--the true cost, which is the last bullet point with the red dot, is $2.2 trillion and counting; but as Ms. Pelosi said--and I quote her in the third bullet point here--``we have to pass the bill to find out what's in it.'' That was before the bill passed. Clearly, we are finding out now, unfortunately, what the true cost is.

Mr. Speaker, I want to yield additional time to my colleague from New York.

Mr. Speaker, the gentlewoman is absolutely right.

As I pointed out in that $500 billion-plus cut-out of the Medicare program to help pay for this new entitlement of the Patient Protection and Affordable Care Act, $120 billion of the $500 billion-plus was taken from the Medicare Advantage program. The Medicare Advantage program enrolls about 20 to 25 percent of our Medicare beneficiaries.

Why so many?

We are talking about, maybe, 11 million or 12 million who sign up and decide that, rather than the traditional fee-for-service and just pick a doctor out of the Yellow Pages who accepts Medicare, it's more like a health maintenance organization that emphasizes wellness, that emphasizes prevention, tests that are not typically covered under traditional fee-for-service Medicare, like colon cancer screening, breast cancer screening, mammograms for women, especially between the ages of 40 and 60, prostate cancer screening for men, annual physical examinations, follow-ups from a nurse practitioner within the doctor's office, maybe even on a monthly basis to make sure that the senior is taking the medication that was prescribed by the primary care doctor.

All of these things are included with Medicare Advantage. That's why it's called Medicare Advantage. It is an advantage with very little additional cost. In fact, people who are under those programs typically don't have to buy supplemental insurance to cover co-pays and deductibles and hospital care after they've exhausted their benefits. So that's why so many choose that.

Yet what we have done is we've stripped--we've gutted--that program so badly that, of those 12 million, it's estimated 7 million of them will lose that coverage under Medicare Advantage. They'll have to get it under the traditional Medicare, and they'll have to pay $130 a month extra for that supplemental whether they get it through a plan that's endorsed by the American Association of Retired Persons or through some health insurance company, but the average cost is going to be an additional $130 a month for those folks.

So as we talk about the cost, I do want to shift, Mr. Speaker, to the cost

to employers. In this next slide, where the title says, ``ObamaCare Hurts Workers, Increases Costs,'' the majority of employers anticipate health care reform will increase health costs. And most say they plan to pass the increases on to their employees--88 percent plan to do that--or reduce health benefits and programs, 74 percent.

This idea of setting up these exchanges throughout the 50 States and territories and that only 6 million people who have employer-provided health insurance can keep it, they won't need to be on the exchanges, Mr. Speaker, that is absolute poppycock. It's probably going to end up being about 130 million people who get their health care provided today by their employer will end up in those exchanges. And that's why I say this cost that was estimated by the CBO of $900 billion will be in the trillions, because when all of these people morph out of the employer- provided health care onto these exchanges, think how many of them will be eligible for a Federal subsidy to help them pay for that insurance. Because the law says, the so-called ``Affordable Care Act,'' that anybody with an income of less than 400 percent--not 100 percent, not 200 percent, not 300--400 percent of the Federal poverty level--which is getting close to $90,000 for a family of four--I think of my four children and their families of two and three and four, and I know what their incomes are--the Federal Government will be subsidizing so many people that the cost, the true cost will be astronomical, and it is something that we cannot afford. That's why our representative from New York and our other representative from Georgia spoke earlier about we can't do this, we can't afford to do this. We need to repeal this law. It is a bad law.

I've said before, Mr. Speaker, that in my humble opinion I think it's the worst law that has ever been passed in this Congress. There have been some folks on the other side of the aisle--well, not on the other side of the aisle, but the more liberal media who took me to task for saying that, but I truly believe it. I truly believe it's one of the worst laws that was ever passed. And we have made every effort to repeal it.

One of the first things we did in the 112th Congress was pass H.R. 2 to repeal ObamaCare. We sent it over to the Senate, and the Senate-- which is controlled by the Democratic majority and led by the Senator from Nevada, Harry Reid--just simply, I guess, put that in file 13, and H.R. 2 is sort of dead in the water over on the Senate side.

So what we are doing now, it is our obligation because of what the American people have told us: Over 60 percent of them a year after passage of the bill, despite the fact that Ms. Pelosi said, once we pass it and you find out what's in it, you'll like it. No, they don't. They don't like it. They don't like it one darn bit better, and they wanted us to repeal. We made every effort at repeal.

And now we're into Plan B, Mr. Speaker. Plan B, of course, is to try to defund especially the parts of the bill that are on automatic pilot, that we have no control over. And when I say ``we,'' I don't mean the new Republican majority in the House of Representatives; I mean every Member of Congress--100 Senators, 435 Members of the House, both sides of the aisle. For goodness sakes, we ought to have control over the spending.

This is not a poster. I don't have a poster on this one. But tomorrow, in the Energy and Commerce Committee, Mr. Speaker, the committee on which I am proud to serve, along with several of our other House GOP doctor members, we are going to have a markup on several bills to change this automatic pilot spending under ObamaCare and put it into the more typical discretionary spending where Members of Congress can say, do we want to spend that money? And if we do want to spend the money, how much do we want to spend? And that we have oversight and we can make sure every year that we look at the program, and if it's not working then defund it.

And these bills--and I'll just mention them real quickly--H.R. 1217, a bill to repeal the prevention and public health fund, $17.5 billion that the Secretary of Health and Human Services has control over, a fund of money that she can spend in any way she wants to. You think back to the ads that we saw with Andy Griffith as the pitchman on television last year about the great value of this new law and how it's going to strengthen and improve Medicare. How you do that by cutting $500 billion out of a program is beyond me. But that money, that $17.5 billion in this prevention and public health fund, can be spent indiscriminately by a decision made by whoever the Secretary of Health and Human Services might be. H.R. 1216, H.R. 1215, H.R. 1214 and H.R. 1213, in the aggregate, this is over $18 billion worth of spending that we Members of Congress have no control over. We're going to get control over it, though, and we're going to defund anywhere we feel that it is wasted, duplicative spending that the American people can ill afford.

I want to go ahead and point out a few other things that are on the slides, Mr. Speaker. I mentioned, of course, the $575 billion in cuts from the Medicare program. I mentioned the 7.4 million people who will lose that coverage under Medicare Advantage because of that $126 billion pay-for. I didn't mention, though, on this slide the third bullet point.

Many physicians may stop taking Medicare patients because reimbursements will be below the cost of providing the care. Now, is that Representative Phil Gingrey from the 11th of Georgia, is that a statement that I've made? Well, maybe I have made it. But I'm quoting the Actuary of Medicare, Richard Foster, who we had last week as a witness before the Energy and Commerce Committee talking about some of these things. This bears repeating, Mr. Speaker; ``Many physicians may stop taking Medicare patients because reimbursements will be below the cost of providing the care'' Richard Foster, Committee on Medicare and Medicaid Services, Chief Actuary.

Today, doctors are reimbursed under the Medicare program by a formula, an arcane, very difficult--you talk about calculus being difficult; understanding the sustainable growth rate formula to determine how doctors are reimbursed for providing their service, whether it's their brain power or their surgical skills, is beyond anybody's comprehension. And every year, for the last 6 or 7 years, when you apply that formula to the next year's reimbursement level, there is a cut from the last year's reimbursement--2 percent, 3 percent, 4 percent--to the point now, Mr. Speaker, what we have done, of course, we here in the Congress have mitigated those cuts and said we're not going to enact those cuts because these doctors will not be able to provide the care, just as Mr. Foster, the Actuary, said. And if we don't put a bandaid on these cuts and mitigate them, then the doctors will just drop out of the program. And I don't care how much you expand access and hand out more insurance cards, if there are no doctors there to see you, you're not going to have care. You do not have decent care--you don't have any care.

So in this bill, in this new law, not only is that formula still there, and the doctors are facing a 31-percent cut in their reimbursement if we don't mitigate it once again come December 31 of this year, not only is that on their backs, but in ObamaCare, there's this new provision called IPAB, this new bureaucracy--Independent Payment Advisory Board--that's going to actually cut the doctors even more. The Actuary is right: We're not going to have doctors providing the care.

And that's because we've taken money out of this program and put it into an entirely new entitlement program for the most part for young people. Some entitlement, when you force them to buy health insurance in many instances when they don't need it and they don't want it.

Mr. Speaker, I see we've been joined by the cochairman, along with myself, the cochairman of the House GOP Doctors Caucus, my classmate from the 108th Congress, the Member from Pennsylvania, my friend and colleague, Dr. Tim Murphy.

I yield to the gentleman from Pennsylvania.

I want to thank you, Dr. Murphy, and I appreciate you coming.

Mr. Speaker, I thank you for the time. I know our time is up.

I just refer to our last poster in conclusion: Repeal and Replace ObamaCare.

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

The Patient Protection and Affordable Care Act included $105 billion of directly appropriated mandatory funding of numerous programs and provisions included in the law. For example, section 4101(a) of the Patient Protection and Affordable Care Act provides $50 million in mandatory spending for construction and expansion of school-based health centers every year, from the inception through 2013, for a total of $150 million. In our current financial situation, it is not only necessary but it is our responsibility that we examine all of our spending and make all necessary adjustments.

H.R. 1214 is a simple bill aimed at a simple goal--to get some of the spending that the Patient Protection and Affordable Care Act advanced inappropriately. Section 4101(a) of the Patient Protection and Affordable Care Act funds only the construction of school-based health centers. The $50 million in grants are for construction only and there is an express prohibition on these funds being used to provide health services. No such provision was in the bill passed by the House. You will recall H.R. 3200 was the Health Care Reform Act that the House of Representatives worked through its committees of jurisdiction, on which we held hearings, on which we had debate on the floor of the House, and which passed the House in November of last year. It had no such provision in the House Democrats'-passed bill. Since no such provision was included in the health bill, and if the Senate Democrats considered the school-based health centers important enough to receive mandatory funding, why was the mandatory funding strictly limited to the construction of the buildings? Not one cent is guaranteed to see a child, but automatic checks out of the Treasury to build these centers.

I will point out that section 4101(b) of the Patient Protection and Affordable Care Act created a new discretionary grant program for school-based health centers. But this grant program requires them to use the funding to provide health care services. However, the President's budget did not fund section 4101(b), failing to provide school-based health centers money expressly for the purpose of actually providing the service.

Fundamentally, we might even have some agreement on school-based health centers. I am on record of having supported them in the past, and I believe opening health care points of access is important. I want to do more in this realm. But providing mandatory spending, forced spending to construct facilities without adequate safeguards if they will provide care is irresponsible and it certainly abdicates the pursestring nature of the House of Representatives. We are the people's House. It is our obligation to oversee the money that is spent on behalf of the people of the United States.

Not one guarantee of a doctor, not one cent of payment for an immunization, not once ounce of common sense is included in the policy. I will note that this bill does not touch the discretionary program to provide care. I urge my colleagues to support restoring a little fiscal restraint and a little responsible policy to a small part of the law which will destroy the practice of medicine as we know it in the Nation and put the taxpayer on the hook for trillions of dollars in spending.

I reserve the balance of my time.

Mr. Chairman, I yield myself 1 minute.

This mandatory spending was not in H.R. 3200, the House-passed health care reform bill. Make no mistake, I voted against 3200 just as I voted against 3590. But, nevertheless, the bill that subcommittee Chairman Pallone last Congress brought through did not have mandatory spending for school-based health centers in his bill.

Some of us get up today and act as if mandatory spending for this program is imperative, that it's the only way to go, that we can't provide care if we don't have mandatory spending for building the exam room. But, again, I remind my colleagues on the other side that simply an exam room with an exam table, a thermometer and a sphygmomanometer does not provide 1 ounce of care to a child. It does not save any money in an emergency room visit. It is simply an exam room sitting unutilized because the President of the United States said, I'm going to zero out the discretionary funding for staffing these clinics. That's why this makes no sense.

I urge, again, support for the underlying bill. It is important to bring this back into the authorization process so our appropriate committees can have the oversight over the expenditure of these funds.

I reserve the balance of my time.

I yield myself 1 minute.

Mr. Chairman, this language was put in the Senate's health care bill when the Senate was giving out favors, and there really was no rhyme or reason to put this program in as a program under mandatory funding.

Congress has traditionally provided funds to health centers, including school-based health centers, to provide for care, not for construction. To do it the other way around would lead to situations where a center is built but no care is delivered. Both policy choices require local funds to be spent, but only the policy for paying for services, not construction, guarantees that money won't be wasted or, worse yet, never used to deliver 1 ounce of care.

I reserve the balance of my time.

I yield myself such time as I may consume.

And nothing in the bill under consideration, H.R. 1214, would change anything about what was just relayed to us about the school-based clinics in the gentleman's district.

Can I just point out, again, that the discussion that we're having today revolves around the use of advance appropriations in the Patient Protection and Affordable Care Act, thereby making that spending mandatory.

Now, just a brief civics lesson. Medicare is mandatory spending. We have no discretion on that. We must fund Medicare to the extent of the number of dollars that are going to be drawn on the Federal Treasury. Same for Medicaid. We have other health care programs that are, in fact, discretionary.

Our veterans, who I'm sure the gentleman would argue are no less worthy, are funded under a discretionary program.

The difference between a mandatory and a discretionary program is that the authorizing committee, in this case the Committee on Energy and Commerce of which I am a member, of which the gentleman from New Jersey is a member, the authorizing committee sits down and decides whether or not the spending is useful. If it is, we authorize the expenditure. We send it over to the appropriations committee who, if they agree, writes a check for the amount of money that we have authorized and not one bit more.

But the key here is it goes through a regular order process; and one of the things, I don't know about the gentleman from New Jersey, but what I heard when I went home is the Federal spending is out of control; you've got to get a handle on Federal spending. Well, here's a point where we can get a handle on some Federal spending. It should never have been an advance appropriation in the Patient Protection and Affordable Care Act.

I don't know whether that was carelessness or Machiavellian, but it doesn't matter. It's got to be fixed. The American people want us to fix that. That was one of the reasons they voted en masse against the Patient Protection and Affordable Care Act November 2, 2010. That is one of the reasons that the gentleman is sitting in the Speaker's chair today is the public revulsion to how last Congress conducted its business.

We have a chance now to reclaim a little of our honor, a little of our integrity. Let's bring that funding back into the authorization realm in which it belonged and not simply pass it off to the administration. It's mandatory funding. It has to be done. Whether or not the administration is going to fund a doctor or nurse to work in that clinic, you've got an exam bed, you've got a thermometer, you've got a sphygmomanometer, but you don't have one ounce of care delivered to the people who actually need it. Therefore, you are not saving money. You are only spending money. The American people have asked us to be wiser stewards with their cash.

I reserve the balance of my time.

I yield myself such time as I may consume.

Mr. Chairman, here is the simple truth. What takes health care away from children is sending checks to localities for land acquisition when you've got no intention of staffing the clinic that is going to be built.

Let me just remind people what the argument is about, and I will stipulate that we are not talking about a vast sum of money here like we were in the previous bill. But every instance of advance appropriation in the Patient Protection and Affordable Care Act represents an opportunity for this Congress to reclaim some of its function as the people's House in being in control of Federal spending.

But here's what the argument is about. Section 4101(a) of the Patient Protection and Affordable Care Act under subtitle B, increasing access to clinical preventive services, paragraph 5 of 4101(a), appropriations: out of any funds in the Treasury, not otherwise appropriated, there is appropriated for each of the fiscal years 2010 through 2013 $50 million for the purpose of carrying out this subsection. Funds appropriated under this paragraph shall remain available until expended. No funds provided under a grant awarded in this section shall be used for expenditures for personnel or to provide health services.

It could not be clearer. Now, nothing in the bill that we have under consideration today actually does anything to the provision of services because, after all, those are under an authorization. Section 4101(b), authorization of appropriations: for purposes of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2010 through 2014.

But the operative words here--``there are authorized to be appropriated''--not that there are appropriated from the Treasury. It's okay for us to authorize that appropriation. Our committee is an authorizing committee. We are not an appropriating committee.

Mr. Chairman, I understand the difference between an authorizing committee and an appropriating committee. I take an annual field trip to the National Institutes of Health. At the National Institutes of Health you see all these beautiful buildings. They are all built, and they're named after very famous men who served in the United States Congress. Every one of those men is an appropriator. There is no building named after an authorizer.

Still, the work we do is important--I submit it is vital--to the American people that we do our work to evaluate whether or not the expenditures are indeed in the best interest of the American people; and, further, if we're really doing our job, we'll come back and do oversight over those authorizations to make sure those funds are expended in the manner in which they were intended. That's the way you guarantee that that care gets to the child that will ultimately save money to keep the child out of the emergency room, not just by sending checks to localities to purchase land.

I reserve the balance of my time.

Mr. Chairman, let me respond to something that was just said by the chairman emeritus of the Democratic side of the Committee on Energy and Commerce. Of course I have all respect for the chairman emeritus and certainly treasure every day that I served under his direction as chairman in two Congresses.

But the statement that I cannot let stand is that the Patient Protection and Affordable Care Act saves anyone in any universe, in any dimension, any money at all. This was refuted by the chief actuary for the Centers for Medicare & Medicaid Services less than a month after the President signed the Patient Protection and Affordable Care Act. I do not know why we have to continue to hear this fairy tale about $142 billion being saved under PPACA.

At this point, I would like to yield 2 minutes to the gentleman from Louisiana, Dr. Fleming.

I yield the gentleman an additional 30 seconds.

Mr. Chairman, I would just point out to the gentleman how shortsighted and misguided that is, that this language was put in by the Senate when they were giving out favors. Sending checks to localities without guaranteeing the actual coverage, without guaranteeing the actual doctor or nurse be there, does not do anything as far as furthering care.

I would now yield 2 minutes to the gentlelady from North Carolina (Ms. Foxx).

Mr. Chairman, I yield 3 minutes to the chairman emeritus of the full Committee of Energy and Commerce, the gentleman from Texas (Mr. Barton).

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

Mr. Chairman, I yield 1 minute to the gentleman from Georgia (Mr. Graves).

I would agree that it is going to be an uphill battle in the Senate, but I believe we can be successful. I would just point out to the gentleman that the President has not issued a veto threat against this legislation.

At this point, I yield 2 minutes to the gentleman from Georgia (Mr. Kingston).

Mr. Chairman, may I inquire as to the amount of time that is left?

I yield 30 seconds to the gentleman from Georgia (Mr. Kingston).

Mr. Chairman, I yield myself 1 minute.

The Federal deficit is now the biggest concern of business economists and, indeed, the American people at large. Job creators are sitting on the sidelines while Washington continues to spend more money that it doesn't have.

Despite the sobering facts, my colleagues on the other side of the dais in the Energy and Commerce Committee have not proposed a single cut, not one single spending cut under our committee's jurisdiction.

Now, sure I can be criticized today for only trying to save, what, $200 million? I don't know about New Jersey, but in my district back in Texas, $200 million is still real money.

When challenged at last week's subcommittee markup, all Mr. Waxman could come up with were tax increases and cuts to the farm program. We can and should do more to get our spending under control. Our committee, the Committee on Energy and Commerce, has an obligation to be front and center in that fight.

I reserve the balance of my time.

I yield myself 30 seconds.

Again, let me remind people what we are talking about today. We are talking about taking away advance appropriations in the Patient Protection and Affordable Care Act for construction purposes--not for running the darned clinic but for construction purposes.

An eligible entity shall use funds provided under a grant ordered under this subsection only for expenditures for facilities. No funds provided under a grant ordered in this section shall be used for expenditures for personnel or to provide for health services.

I yield 1 minute to the gentleman from Indiana, Dr. Bucshon.

I yield myself 30 seconds.

Mr. Chairman, we just heard a moment ago from the gentleman from New Jersey perpetuation of the fantasy that the Patient Protection and Affordable Care Act is going to save anyone in this universe or a parallel universe or a parallel dimension any money.

Make no mistake: This law costs vast sums of money. When the subsidies and the exchanges hit, the tap on the Federal Treasury is going to be unlike anything this country has ever seen.

Congressional Budget Office talk about saving money was pure fantasy. The chief actuary for the Centers for Medicare & Medicaid Services exposed that fantasy for what it was less than 1 month after Congress voted on this bill. We voted on this law without actually having correct information because I believe the Secretary withheld the information from us.

I reserve the balance of my time.

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

I yield myself the balance of my time.

Mr. Chairman, I'll tell you what's not rational. It's not rational to spend this money and say you're prohibited from providing care. Let's be honest. The money for construction is duplicative. It was offered up in the stimulus bill previously. So we're duplicating a previous Federal expenditure in forward funding, advance funding the Patient Protection and Affordable Care Act. That's what doesn't make sense.

A previous speaker on the Democratic side called me mindless. That is mindless. It was mindless to pass this bill over the objections of the American people, to never listen to the voices of the people that were literally ringed around this Capitol a year ago who said kill this bill. Well, now we have a chance to bring back a little bit of that spending, to bring it back into the arena in which it belongs, which is the United States House of Representatives, the people's House.

The mandatory spending was not in the bill that passed this House in November of 2009. This language was put in by the United States Senate. And why was it put in by the United States Senate? Because they were playing ``Let's Make a Deal.'' They had to get to 60 votes. They didn't know how to get there. They got there by buying votes, and this small provision, someone must have sold out pretty cheaply, this small provision was one of the provisions that allowed them to do that.

Again, I would remind my colleagues that you cannot use the money that is provided in 4101(a), you cannot use that money to have a doctor or a nurse in the clinic. In fact, you are expressly prohibited from that. I suspect that is why the President has not issued a veto threat on this particular piece of legislation, because he himself included no money on the discretionary side that is actually going to provide the services of a doctor or a nurse.

Look, we've got one small chance to reclaim some small part of our sanity in the United States House of Representatives, in the people's House. The forward funding, the advance funding, the direct appropriations that were contained within the Patient Protection and Affordable Care Act were an anathema to everything that people in this country understand about what is the role of their Federal Government. After all, they willingly give up a little bit of their rights in order to have their lives run more orderly. But they don't ask us to run roughshod over Federal spending and then claim a greater and greater share of their lives.

Yes, it is unfortunate that we have had to spend all day here debating this bill. I don't dispute that fact. We should never have been here in the first place. The advance funding should never have been included in the Patient Protection and Affordable Care Act. And why was it? Because the Democrats knew last year they never intended to do a single appropriations bill, so the only way to get this dog up and running after its passage last year was to push the appropriations out the door in the language of the bill. That's what we've got to correct right now. That's what these arguments are all about.

Yes, it's going to be tough sledding in the Senate. Yes, we don't have an ally down at the White House. But the American people expect us to do this work and they want to see us do that work. I urge an ``aye'' vote on the underlying bill.

I yield back the balance of my time.

Mr. Chairman, I move that the Committee do now rise.

Mr. Speaker, I thank the gentleman from New York for giving me the customary 30 minutes, and I yield myself such time as I may consume.

It's my understanding this is his first rule that he is managing in his name on the floor of the House, and I congratulate him in that regard. In the 111th Congress, I had the opportunity to manage a number of rules, and I had a perfect record--I never lost a rule. This Congress as well, I too have a perfect record--I have never won a rule. I wish the gentleman from New York success in his efforts and congratulate him on his appointment to the Rules Committee and look forward to working with him throughout the 112th Congress.

Today, while millions of Americans remain unemployed and millions more await the chance to receive affordable health care, the Republicans are spending another week rehashing old debates instead of talking about creating jobs and, in fact, in this case, undermining Americans' access to quality health care.

This rule brings forth two bills. First, the majority brings forth, under this bill, legislation that will prevent Americans from accessing the exchanges which are competitive marketplaces in which to buy private insurance.

Now, there's a lot of subterfuge and misinformation in this debate. For instance, there is no ObamaCare option. There is no public insurance option that we are even discussing here. What is being discussed is a marketplace in which individuals, primarily those who work in small businesses or are self-employed, will have access to choose from the private policy of their choice.

According to the Congressional Budget Office, under this Republican proposal, 2 million fewer Americans will be enrolled in exchanges in 2015. The Congressional Budget Office also says that H.R. 1213 will result in higher premiums in the exchange. Again, a bill that is delivering higher premiums for American citizens--hardly, hardly the outcry that I have heard on the stump.

I had a chance to have public meetings in the last 2 weeks back in our district, as many Members of Congress have. My constituents, Mr. Speaker, did not request that we deliver higher health insurance premiums. They wanted us to deal with the deficit. They wanted us to deal with jobs and the economy. Not a single constituent of mine asked for higher health insurance premiums, which seems to be a priority of this Congress.

Now, there may be a talking point involved, and certainly both of these bills today were also included in H.R. 2, which was a repeal of health care reform, largely. Now we are looking at individual pieces. But this new marketplace has historically been an idea that has had strong bipartisan support: to have competitive health care exchanges; to keep in tact America's employment-based system while expanding access to tens of millions of people, including small businesses and people who are self-employed. Truly, the exchanges represent an opportunity for a more competitive and a more transparent marketplace that empowers consumers to make the choice between private insurers.

The other bill that is brought forth under this particular rule, after we have dispensed with denying health care to an estimated 2 million more Americans through the exchanges, we are also, in this next bill, eliminating funding for school-based health clinic construction, renovation, and equipment. That would particularly harm our Nation's health care services, especially for children, youth, and families and those with low incomes.

School-based health care clinics serve students whose access to health care is limited; and frequently, the scope of services is determined by school officials in partnership with parents and community-based health care initiatives. Services are designed to identify problems early, provide continuity of care, and improve academic participation. These programs save money by providing access to preventive care that frequently alludes many of the families affected.

And yet also, while we are denying basic preventive care to our Nation's youth, the passage of this bill will also deny job opportunities to Americans all across the country who are ready with shovel-ready projects to begin improving and building school-based health care clinics. So here we are with a bill: less jobs, less health care, less education--hardly the priorities that I think the voters wanted for the 112th Congress.

Democrats believe strongly that we need to make tough choices to end the deficit and end the climbing spiral of debt. But what we are left with with these two bills, as separate from H.R. 2, is actually the worst of both worlds. The Republicans leave in place the taxes that were used to pay for health care reform--they leave in place in these two bills the medical device tax; they leave in place the tax on unearned income--and yet they remove the benefits to the American people from these taxes.

Whenever the American people agree to any degree of taxes, they want to see a tangible result. But what is being done with these bills is leaving in place the taxes of health care reform and removing the benefits to the American people of health care reform. That's hardly a balanced and fair approach, and it's one that the House should reject.

I would remind my colleagues of House Resolution 9, which I supported on the floor of the House of Representatives. It dealt with 13 items out of the original jurisdiction of our Rules Committee before the gentleman from New York joined our Rules Committee. We instructed the House on replacing health care reform and what some areas for working on it would be.

I would like to submit to the Record in the context of this debate, Mr. Speaker, House Resolution 9, which was adopted by the House and, indeed, discusses changing existing health care law within the various committees of jurisdiction to foster economic growth and private sector job creation; to lower health care premiums, preserve a patient's ability to keep their health care plan, provide people with preexisting conditions affordable access to health care; and many, many other good ideas.

But rather than discussing any of these 13 points that were contained in House Resolution 9, the business of the committees of jurisdiction has apparently been not only to repeal health care reform generally but now to repeal each of the individual components while leaving the taxes in place. We would encourage these committees to comply with House Resolution 9. And I think by rejecting this bill before us today, we are sending a powerful message to the committees of jurisdiction that rather than talking about repeal, repeal, repeal, they need to also discuss replace.

What are we going to do if the exchanges don't exist or are handicapped to provide people with preexisting conditions access to affordable health care? Again, if we repeal the support for the exchanges, how are we fostering economic growth and private sector growth? How are we encouraging small businesses and self-employed people to have access to the same health care services at a similar cost that large employers already have?

I call upon my colleagues to reject this rule and both underlying bills and begin the discussions of how to improve and build upon health care reform, finding a common ground between Members of both parties and saving taxpayers money to help reduce the deficit.

H. Res. 9

In the House of Representatives, U.S., January 20, 2011.

Resolved, That the Committee on Education and the

Workforce, the Committee on Energy and Commerce, the

Committee on the Judiciary, and the Committee on Ways and

Means, shall each report to the House legislation proposing

changes to existing law within each committee's jurisdiction

with provisions that--

(1) foster economic growth and private sector job creation

by eliminating job-killing policies and regulations;

(2) lower health care premiums through increased

competition and choice;

(3) preserve a patient's ability to keep his or her health

plan if he or she likes it;

(4) provide people with pre-existing conditions access to

affordable health coverage;

(5) reform the medical liability system to reduce

unnecessary and wasteful health care spending;

(6) increase the number of insured Americans;

(7) protect the doctor-patient relationship;

(8) provide the States greater flexibility to administer

Medicaid programs;

(9) expand incentives to encourage personal responsibility

for health care coverage and costs;

(10) prohibit taxpayer funding of abortions and provide

conscience protections for health care providers;

(11) eliminate duplicative government programs and wasteful

spending;

(12) do not accelerate the insolvency of entitlement

programs or increase the tax burden on Americans; or

(13) enact a permanent fix to the flawed Medicare

sustainable growth rate formula used to determine physician

payments under title XVIII of the Social Security Act to

preserve health care for the nation's seniors and to provide

a stable environment for physicians.

I reserve the balance of my time.

Mr. Speaker, I yield myself 1 minute to respond before further yielding.

The gentleman from California again identified several areas where there are opportunities for both parties to work together: allowing the sale of insurance across State lines, something I certainly support; pooling for high-risk individuals; reforming the medical liability system.

Again, it really goes to a question of if we are, in fact, repealing in part or all various parts of the health care reform, what is replacing it. When we talk about pooling of high-risk individuals, if we can put together a way of doing that, that can effectively serve as a marketplace or as an exchange.

What this bill simply does is repeal the support for the exchanges, leaving many of these with preexisting conditions, particularly those who work for small businesses or are self-employed, entirely in the lurch. As we discuss how to improve health care for the American people, it's critical to actually have the solution to the policy problem that's been identified.

The gentleman talked about an inadequate selection process with regard to the use of funds, inadequate congressional oversight. Again, why not bring a bill forward that talks about setting the right process in place to allow for the correct oversight of the use of these funds? It's a question of making it work for the American people rather than throwing the baby out with the bath water.

With that, Mr. Speaker, I am proud to yield 2 minutes to my colleague, the gentlewoman from Maryland (Ms. Edwards).

I yield the gentlewoman an additional 30 seconds.

Mr. Speaker, I yield myself 30 seconds to respond really briefly.

In the minority report from the committee, it discusses the oversight of the exchanges. Specifically, the Government Accountability Office is required to review the operations and the administration of the exchanges. In addition, not one, not two, but three congressional committees--Energy and Commerce, Oversight and Government Reform, and other congressional committees--can provide the oversight of the implementation of the Affordable Health Care Act according to section 1311.

Again, if there is additional oversight, as the gentleman from California seeks, why are we not discussing a bill that provides additional oversight? We all want this money to be spent correctly and well.

With that, I am proud to yield 3 minutes to the gentlewoman from Texas (Ms. Jackson Lee).

I yield an additional 30 seconds.

I yield myself 15 seconds just to restate what my colleague, the gentlewoman from Maryland, stated: If the Republicans are against the public option, if they are against the private option in the form of the exchanges, the only option left is pay more insurance premium. That simply is not acceptable to the American people.

With that, Mr. Speaker, I yield 3\1/2\ minutes to the gentleman from California (Mr. Garamendi).

I will be happy to yield an additional 30 seconds to the gentleman from California.

I am happy to yield 2 minutes to the gentleman from California (Mr. Garamendi).

I yield myself the balance of my time.

Mr. Speaker, I want to further discuss the benefits of school-based health centers. A wide range of research and evaluations have demonstrated that school-based health centers are cost-effective investments in our Nation's health care safety net for children and adolescents and also help improve academic performance.

Now, each school-based health program is different, as they should be. Some of the services often include things like well-child and well- adolescent exams, immunizations, treatment for illness or injury, including management of chronic conditions, like obesity, diabetes and asthma; and they also frequently include services like mental health assessment and treatment, prevention programs to help reduce smoking, to help reduce teenage pregnancy rates, to help reduce violence. They frequently include substance abuse counseling and nutrition counseling, as well as dental cleaning.

These are services that prevent costly emergency services and hospitalizations later and help keep kids in school where they should be learning. Most importantly, stronger school-based health centers lead to stronger, more successful children and adolescents across the country. By bringing health care services to the children where they spend most of their day, at school, school-based health centers are a sensible and inexpensive way to deliver basic health care services to children all over the country.

This unwise legislation undermines our fiscal condition by wasting an opportunity to leverage local funding. Providing capital support to school-based health centers is a Federal investment that is a good deal for taxpayers. That is because when we provide modest Federal support to school capital projects, local and State funding, in partnership with nonprofits and community health clinics, is spent on operating activities, staffing and other equipment. What a great value for our Federal dollar.

Likewise, the value of this Federal investment is immense to local districts, many of whom are at their bonding capacity, who can't build school-based health centers on their own. However, many of these districts will benefit tremendously, and the students and families, from school-based health care clinics.

The research is clear, Mr. Speaker. Over a decade of studies consistently find positive benefits of school-based health centers. These benefits include better student academic achievement, increased school attendance and reduced tardiness among inner-city children who receive counseling in the school-based health center, fewer school discipline referrals for students who receive mental health services, and increased learning readiness and parental involvement.

As we discuss in this Congress reducing the learning gap, helping all students achieve, and ensuring that every American, regardless of where they live, has access to hope and opportunity through a quality education, school-based health care clinics are an important part of the solution.

In Colorado alone, there are 46 school-based health care clinics in 18 school districts, including one in the Summit County School District, which I represent, which is applying for funding under this program, and another applicant from Eagle County, Colorado. Eight other Colorado applications are going forward under this opportunity, as they are throughout the Nation.

This is the initiative, Mr. Speaker, that Republicans are seeking to eliminate. They say they want a fiscally responsible budget and more jobs, but what we see instead is their priority to stop programs that save money and create jobs and increase student achievement and learning, like school-based health care centers.

There can be no doubt about how the new majority is going about its business. There are no attempts to find common ground, like we have in House Resolution 9, and to work on ways to improve health care or to implement pooling mechanisms or to allow purchasing across State lines of insurance policies. Rather, we are dealing with press releases disguised as legislation that will neither pass the other body nor be signed into law.

That's not governance. That's immaturity. And the only Americans being

asked to sacrifice in the name of deficit reduction are those who have very little, if not nothing, left to lose and no real way to fight back. That's not leadership.

Mr. Speaker, we can and must do better. I urge my colleagues to oppose the rule and the underlying bill.

Mr. Speaker, if we defeat the previous question, I will offer an amendment to the rule to provide that immediately after the House adopts this rule, it will bring up H.R. 1366, the National Manufacturing Strategy Act of 2011. This bill, introduced by Mr. Lipinski of Illinois, will require the President to develop a national manufacturing strategy in order to boost traditional and high-tech manufacturing, spur American job growth, and strengthen the middle class.

This bill passed the House on a bipartisan vote of 379-38 in the 111th Congress. Manufacturing is a cornerstone of our Nation's economy. The U.S. Government, through its policies and programs, has major influence on our manufacturing base, and our national security, energy, and transportation systems rely on that base. We must unify government programs, leading to increased efficiency, and promote policies to promote our domestic manufacturing base to help our competitiveness in the global market.

Mr. Speaker, I ask unanimous consent to insert the text of the amendment in the Record along with extraneous material immediately prior to the vote on the previous question.

Mr. Speaker, I urge my colleagues to vote ``no'' and defeat the previous question so we can debate and pass jobs legislation today, rather than legislation to increase the health care premiums that Americans pay.

I urge a ``no'' vote on the rule and the underlying bill, and I yield back the balance of my time.

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

Mr. Speaker, I demand a recorded vote.

I yield myself 3 minutes.

Mr. Chairman, once again I'm listening to my colleague Dr. Burgess, whom I respect, and he's talking about the common sense being lacking on the Democratic side. After listening to him, I think the rationale and the common sense is lacking on the Republican side.

My colleague from Texas has said over and over again he supports school-based clinics. He even supports Federal funding for school-based clinics. Then what is the possible rationale for posting this bill?

Many of my colleagues on the other side have said today they're opposed to the entire Affordable Care Act. They're opposed to funding the entire Affordable Care Act. Yet somehow today they're taking little pieces of the Affordable Care Act that they even agree with, from my understanding in listening to my colleague from Texas, and still saying we're going to defund them. I defy my colleague to really understand why.

School-based health clinics are a tremendous success story. These programs provide primary care, mental health, dental health services to vulnerable children across the country in every State. Multiple studies have found that these programs are cost-effective investments. They result in lower emergency room usage, hospitalizations, and Medicaid costs. In fact, patients seen at school-based health centers cost Medicaid on average $30.40 less than comparable non-school-based health center patients.

This is saving the Federal Government money. That's the bottom line. And what we're trying to do here is to basically provide for construction, renovation, and equipment for these centers. Now, in order to get the grant for that, you have to show that you have the funds to operate the center. So when Dr. Burgess says, why are you paying for construction, why are you paying for renovation, but you're not paying or you're not providing for operations? Every one of these has to show that they have the money to do the operations before they get the money for construction. What does construction and renovation mean? It means jobs.

I repeat again, when I was home for the last 2 weeks, all I heard from my constituents is, When are you going to improve the economy more? When are you going to create more jobs? This is a program that creates jobs, helps kids, provides for their well-being and their health, and it's all preventative. These projects have to be shovel ready in order to be funded. So we're talking about money that's going to be immediately spent to put these centers together and to renovate them.

I keep hearing my colleagues say repeal and replace. That's the mantra with the health care bill: We want to repeal it and replace it. But I never hear anything about replace. All I hear about is repeal, and in this case repealing a program that is a proven success.

It makes absolutely no sense to pass this bill. I hear my colleagues on the other side say over and over again

they're for these clinics, they're for these centers. Then why in the world do you bring this bill to the floor?

I urge my colleagues to oppose this legislation.

I reserve the balance of my time.

I yield myself such time as I may consume.

Mr. Chairman, again, Dr. Burgess talks about how we're spending money on construction, renovation, but we don't provide mandatory spending for operations. As I said, in order to get the grant under the Affordable Care Act for construction of a school-based health center, you have to show that you have the money to operate.

So what does that mean? That means that we are using some Federal dollars to attract either State or in many cases private dollars to set up these centers. What is wrong with that? They are guaranteed that once the money is spent on construction and creating the jobs that come from the construction or renovation that the money is available to operate the centers. There's nothing wrong with that. It's actually a good thing. It promotes a Federal-State cooperation, and it brings in some private dollars as well.

The other thing I would point out is my colleague from Texas keeps talking about mandatory appropriations. The fact of the matter is that health care initiatives over the years, Democrat and Republican, have provided some mandatory, some discretionary. The same thing we're doing here. The fact of the matter is that Medicare, Medicaid, and a lot of other Federal health programs pay for health care services with mandatory expenditures. And a lot of that is for acute care, acute illness, injury, or chronic diseases. Now, there's no similar approach when it comes to promoting wellness, preventing disease, and protecting against health emergencies. So here for the first time now we're going to have a combination of some mandatory and some discretionary spending for a preventative program, a clinic, a center for kids in their schools that actually helps and prevents them from going to a hospital, to an emergency room, to be institutionalized. So I just think this is false, this notion of mandatory versus discretionary.

The bottom line is if you care about school-based centers and you want to have them, then I think you should oppose this bill because the legislation that this bill is seeking to kill, the Affordable Care Act, for the first time provides funding to put up a lot of these school- based centers. And this is what we need as a preventative measure to prevent these kids from having more serious problems, going to the emergency room. Let's give them primary care up front so they can stay well.

I reserve the balance of my time.

Mr. Chairman, I yield 2 minutes to the gentleman from Connecticut (Mr. Courtney).

I yield the gentleman an additional 30 seconds.

Mr. Chairman, I yield 2 minutes to the gentlewoman from California (Mrs. Capps) who is probably the most knowledgeable person in this House on this subject of school-based care.

Mr. Chairman, can I inquire of the time on both sides?

I yield 2 minutes to our distinguished ranking member emeritus, the gentleman from Michigan (Mr. Dingell).

I yield 2 minutes to the gentleman from California (Mr. Waxman), the distinguished ranking member of the full committee.

I yield 2 minutes to the gentlewoman from the Virgin Islands (Mrs. Christensen).

Mr. Chairman, I yield 2 minutes to the gentleman from Virginia (Mr. Moran).

Mr. Chairman, I yield 2 minutes to the gentleman from New York (Mr. Engel).

Mr. Chairman, I yield myself 30 seconds.

I have listened to my colleague from Georgia (Mr. Kingston), and I can't believe he is blaming the deficit on President Obama. We had 8 years and two wars under Bush, all of the giveaways to millionaires and the special interests, and now, all of a sudden, it's Obama who is responsible for the deficit. We are talking about $50 million a year for probably some of the best schools you could ever imagine with these school-based clinics, and the gentleman is talking about the deficit.

I yield 2 minutes to the gentleman from California (Mr. Miller).

Mr. Chairman, I yield 2 minutes to the gentlewoman from California (Mrs. Davis).

Mr. Chairman, I yield myself 30 seconds.

From the very beginning today, Dr. Burgess, I have said, and many of us have said, the Affordable Care Act saves money and that school-based centers save money. The CBO estimates over $1 trillion in savings from the Affordable Care Act; $30.40 less than Medicaid costs for a kid that goes to a school-based clinic. By repealing this funding for school- based clinics, you are going to cost the Federal Government more money.

So don't talk to us about the deficit. We save money with our legislation, and you are spending more money by proposing this bill.

I yield 2 minutes now to my colleague from New Jersey (Mr. Andrews).

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

Mr. Chairman, I have no further requests for time, and I reserve the balance of my time.

I will yield myself 2 of the 4 minutes and go back and forth with Dr. Burgess here.

The fact of the matter is that the Congress uses the CBO as the official statement, if you will, of our budget and the cost of legislation. That is what we have all agreed on a bipartisan basis we are going to use. I don't always agree with CBO. You have heard me many times say that they don't score prevention enough. The fact of the matter is that is what we are going to use. We have all agreed. And the CBO says that the Affordable Care Act saves over $1 trillion over the life of the bill.

Everyone knows, and I know that Dr. Burgess, even himself, believes in preventative care. That is what these school-based health clinics are all about. They work. They get kids into the clinic or the center, they get primary care. They prevent having to go to an emergency room, to a hospital, or any other kind of institutionalization.

This is what we are trying to do with the Affordable Care Act. We are trying to save money by guaranteeing people get to see a doctor when they need one so they don't get sick. It is all about wellness. That is what it is about. And wellness saves money. The Federal Government doesn't have to spend the money when the person goes to the emergency room and doesn't have any insurance coverage. It is that simple.

I have had this argument many times with Dr. Burgess. I think that, for the most part, he agrees with me, and he has even said today that he thinks the school-based centers are a good thing.

So I really don't understand the basis of this legislation that is being proposed this evening, and I certainly would urge my colleagues to vote against it.

I reserve the balance of my time.

Mr. Chairman, how much time is left?

I yield myself the remainder of my time.

Mr. Chairman, I have said over and over again, I don't understand what the Republicans are up to today. They keep saying that they want to repeal the Affordable Care Act, the health care reform. They keep bringing bills to the floor on a regular basis that would either in a piecemeal or in a large fashion repeal the Affordable Care Act. But the arguments make less and less sense every day as they start to take the pieces of the legislation that they even agree with themselves.

Today, we have been here for many hours. My colleague from Texas and others said that they support school-based clinics. They even went so far to say they wouldn't even have a problem with the Federal Government paying for it.

Support the Federal dollar. Support the concept. Agree that it is a preventative measure.

Then they went on to say that maybe we shouldn't pay for construction; we should only pay for operations. Well, the fact of the matter is that when you submit an application for construction or renovation of the clinic, under this law you have to show that you have the money to operate, and it is pretty clear that if you don't have the building, you are not going to be able to operate.

So, again, I don't understand what they are trying to accomplish here. We all know that these centers make sense. They bring kids who would otherwise not see a doctor to have that opportunity.

I thought my colleague from Virginia (Mr. Moran) really brought home the point when he said that a lot of kids don't even participate in athletics unless they have a school-based clinic because they have to be certified that they are healthy in order to participate in athletics in the school. Well, doesn't that make sense, because then they don't sit around and become obese. They actually exercise. They participate in team sports. They get to the whole collegiality of being involved in a team sport and the exercise and the health benefits of that.

This is a win-win situation. I wish you had picked something else today to bring to this floor to repeal, because this is the worst thing you could have brought to the floor. No one, including yourself, argues that these school-based centers are not valuable, so stop trying to cut them. Stop trying to come up with some fantasy about how you are going to fund some part of it and not fund the other part of it. It is a good thing. It is probably one of the best things we have in this legislation, the Affordable Care Act. I think it is not rational and makes no common sense to pick this out as something to spend two or three hours on to say that this is something we shouldn't do. We should do it. Oppose this legislation.

I thank the gentleman for yielding.

Mr. Speaker, I rise today in support of the rule and of the underlying bills. I would like to draw particular attention to H.R. 1213, which would repeal a provision in the health care law that gives the Secretary of Health and Human Services unlimited spending authority with regard to State-based exchanges.

Let me start by saying that two years ago, when I came to Congress, I looked at the American health care system, and I asked: What's the problem with it?

The problem with the American health care system is that it costs too much money. It's too expensive to go to the doctor or to go to the hospital to receive medical care. If it were affordable, we could all have it. Number two, we have a segment of our population that doesn't have access to affordable health care coverage. Let's say it's a drywall or a sheetrock worker or a carpenter who may be out, working. Maybe his spouse works in a diner, let's say, and they get along just fine, but they can't afford the high premiums. Number three, we have a liability crisis in this country that is forcing the cost of health care through the roof.

Well, what did the Affordable Health Care Act do? It did do number two. It

expanded coverage for some people in this 2,500-page bill--remember, it's this thick--but it did nothing to help curb the costs, and it did nothing for liability, which is forcing the costs of health insurance coverage higher for all of us. I've seen it in my own State of Tennessee. The enactment of this legislation we are talking about today will take $14 billion that we don't have.

Let me just say this: What worries me about Washington, D.C., is that we didn't get the memo. We're broke here. Number two, what is that $14 billion going to do? It's not going to put one more patient in my office who I can see and treat. It's going to the bureaucracy. I see it in education. I see it in commerce. I see the beast, the Federal Government beast, just getting larger and larger and larger. The money doesn't actually get down to a patient for whom I can write a prescription so he can then go to a pharmacy, get the prescription filled, and then get his health care.

So we talk about several simple things that the chairman spoke about just a moment ago very eloquently, and let me show you an example.

I have a Health Savings Account. This little card right here is a debit card. I don't have to fool with the insurance company. I don't have to fool with the Federal Government. I don't have to fool with anybody. I fool with me and my doctor; and who should be making health care decisions are patients and their physicians, not an exchange and not all of this. That's just going to complicate it. I go in with this, and I pay for it, and I usually get a significant discount when I do that.

There are a couple of other things that you can do. Just remember, as to this 2,500-page bill, Mr. Speaker, you could have done two-thirds of it with two paragraphs. One which I agree with, which is in the bill-- and it's one of the few things I do agree with--is to simply let children stay on their parents' plans. Pick your age--25, 26, 27. Number two, simply sign up people who are already eligible for government programs. That's SCHIP and Medicaid. If you do those two things, you can cover nearly 20 million people without this complex, almost incomprehensible bill. We have a Secretary who really has a fungible account from which she can spend billions of dollars that are really unaccounted for. Also, we are knee-deep in red ink. That's the major problem with granting the Secretary access to the Federal Treasury.

The exchanges mandated by this affordable health care law are the first step for Washington bureaucrats in really getting more control of our health care system. Don't get me wrong. I am absolutely for consumer choice because I believe consumer-driven health care is the only way to keep costs down. I think, if we don't do that, you will never get the costs going in the right direction. Instead, this creates a top-down mandate for the type of insurance that will be made available in these exchanges. Remember, when you're looking at this Affordable Health Care Act, the government--not you, the patient, as an individual, as a person, and not the doctor--decides what is an adequate health care plan. So these exchanges are basically just an excuse for unelected Washington bureaucrats to really make our health care decisions for us.

Mr. Speaker, this is not a free market system. It's basically central planning. Patients should be allowed to choose which benefits they want when buying their insurance plans. By passing H.R. 1213, Congress would send a message that we want health care reform that puts the patients first.

There are another couple of things that are very simple in lowering the costs of health care.

It is difficult to cover people in small businesses. There is no question about that. Association health plans allow you to do that, to group and become large groups. There is a second thing you can do that really is so simple I don't know why we haven't done it. I spent a year, when I was running for Congress and after I left my medical practice, and I had to buy an individual insurance policy. It was very expensive. Many people out there in small businesses or individuals who work on farms or in other places do the same thing. To make that insurance more affordable, not only could you have an association health plan, but number two, as an individual, you could have allowed me to deduct my health premiums just like a big business does, just like a huge corporation does, and you would have automatically lowered my cost by 35 percent and would have made insurance more affordable.

So there are many things we could do. This is not what we should be doing. I would urge a vote for the rule.

Mr. Speaker, I have read the bill, all pages of it. I won't say that says a whole lot about my intelligence, but I did read the entire health care bill. When you speak of HSAs only being for wealthy people, that is absolutely not correct.

In my own practice, we have offered the 300 people or so who get insurance through our practice, we allow them to get a traditional health insurance policy or an HSA, and over 3 out of 4 people choose an HSA. And why is that? Because they make the health care decisions, not an insurance company and not a bureaucrat.

I yield to the gentlelady from Texas.

I thank the gentleman for yielding.

Absolutely. What our goal is is to provide affordable health insurance coverage for all Americans. There is no question that I would like to see that in my tenure here in this House, in this body. The problem we have is, how do you get there?

I think the Democratic side is to expand the bureaucracy, more government control. IPAB is a perfect example, and the President spoke of that, and our Medicare patients. I think that is a terrible idea. As a matter of fact, it is a terrible idea. We want to do that. I know there is a way to do it. And, again, to hold the costs down. Remember, that is the problem.

The gentlelady from Texas made a point that insurance premiums would go up. Insurance premiums are going up in anticipation of this particular health plan because, why? The government decides what you must have. You don't get to make that decision yourself. That is done by a bureaucrat, it is done by Congress or whoever decides what is in the plan.

I will give you an example, Mr. Speaker. I don't need in my family fertility coverage at my age. I have three grown children that are raised, educated, have health insurance, good jobs. But I probably will have to have that, because that is a plan that someone else will decide I need--to have fertility coverage. There are things in those bills that I don't need to have personally that I should be able to pick out. And I am just one example. People across this country ought to be making those decisions, not the Federal Government and not a bureaucrat.

Ultimately, what is going to happen in our health care system is, because resources are finite, is that care is going to be rationed. Is the government going to ration it, or are a patient and a doctor going to make those health care decisions? I trust the patient and the doctor to make those health care decisions.

I thank the gentleman for yielding.

Mr. Speaker, in Tennessee, 17, 18 years ago now, we tried TennCare with sort of an exchange. We have had seven or eight different plans competing for your business, and in 10 years the costs tripled in our State because of the intervention of the government.

Medicare, I want to speak to that very quickly. If you're 65 years of age and you have Medicare, you keep it. If you're 55, if the Ryan plan goes through, you keep it. If you're younger and you're a more affluent senior, like I am, you're going to pay for your health insurance. Yes, you are. If you're someone like me with a higher income, you are. If you're lower income and you're sick, you're not. The Federal Government will act like your employer does if you have the employer-based insurance. That part of the premium is paid by them. You pay your part of the premium. Again, it will be means-tested for a higher-income senior.

Why do we think that will work? Because the only plan that I have seen this government ever pass that has come in under budget is Medicare part D. So I think there is a real chance for this to help hold costs down.