Local Flexibility for Transit Assistance Act

Mr. Speaker, it is a privilege to address you here on the floor of the House of Representatives and to once again bring a case before you that I believe will be overheard in an effective way by the American people and responded to you by, of course, your good judicial and prudential judgment.

I came here to the floor to talk about a number of things. I should always bring up the number one thing that is on my mind first. And I know that it's impossible for me to exhaust the subject, but I have given it a significant endeavor over the last year and a half. And now, as things move towards a head, with the continuing resolution negotiations and debate that is taking place and the major decisions that will be formed over the weekend by the leadership in the House and in the Senate in consultation, presumably, with the White House, we expect to see some kind of a proposal come before one or both Chambers next week before the clock ticks down on the continuing resolution that is temporarily funding this government in a piece of shell appropriations that should have never have happened. But that's a subject matter perhaps outside of what I should bring up today, and we should focus on the issues at hand, and they are this:

There was a strong pledge that was made that if Republicans win the majority, Mr. Speaker, that we would cut $100 billion out of this fiscal year's budget. I will submit that, recognizing that we were 5 months into this fiscal year before we had an opportunity to begin that process, that calculates out to be about $61.5 billion if you annualized $100 billion. Even though the initially proposed continuing resolution did not include those kinds of cuts, there was an intense debate here in this Congress driven by the 87 freshmen Republicans to get that number up to a number that was either $100 billion or $100 billion if you calculated it on an annualized basis.

We did come together on that number, and this House did pass H.R. 1, which included in it $61.5 billion worth of cuts out of fiscal year 2011, even though, let me say, the function of the House was not functional during the last 2 or 3 years at least of Speaker Pelosi's time, and there was no appropriations process that one could bring forward, and there was no budget that was brought forward and, therefore, government was being run on stopgap measures of continuing resolutions.

During the lame duck session--the lame duck session being the period of time when Congress comes together to meet after an election. I have said that lame duck sessions should only be to take care of the urgent issues that need to be handled before the new Members of Congress can be sworn in. The old Congress, at least in theory, is delegitimized by the elections that take place. Last year, it was on November 2. They no longer represent the will of the American people. That has been reflected in the election results all across the land. And this House was designed to be a quick reaction strike force to be responsive to the American people.

So our Founding Fathers put it within the Constitution, never amended out, that House Members are up for election every 2 years. And every 10 years there will be a census, and that census is designed then to be used to redistrict the districts. And we have now agreed that 435 is the maximum number of House Members. And as the population moves and as the population grows, every 10 years, we reset the congressional districts to as accurately as possible reflect the new population distribution in America. That goes on, along with every 2 years, there is an election.

So the elections have two purposes. Every 10 years, it is to reflect the population change; and every 2 years, including that 10-year census year election, which comes up in 2012, it's the quick reaction response to the will of the American people. Because our Founding Fathers understood that, if you put people in this office and let them have tenure for life like we are hearing about in States like Wisconsin or Ohio what tenure does to a person's due diligence, then there would be people that would sit here forever and never be responsible to the American people.

They recognize if they would set the Senate up in 6-year election cycles that the Senate wouldn't be accountable within a short period of time, not within 2 years or 4 years, but in 6 years. That was intentionally so the Senators would be more inclined to make long-term visionary decisions, and House Members could come in as the shock troops, so to speak, to bring the quick reaction if the Congress got out of sync with the people.

Well, it's pretty clear, Mr. Speaker, that the Congress got out of sync with the people last year. Actually, they began to get out of sync with the people well before that, more than 4 years ago.

But when President Obama came in he had huge majorities to work with in the House under Nancy Pelosi as Speaker and in the Senate with Harry Reid as leader, even to the extent that they had a massive majority in the House of Representatives, and they had a filibuster-proof majority in the United States Senate. And so they felt their oats, so to speak.

And their ideology, drove them, I think, to--maybe they didn't know it. I think some of them knew it, and I believe the Blue Dogs that were in this House of Representatives that lost their elections last November knew it. They knew they were walking the plank. They knew they were going down into political Davy Jones' locker if they voted for ObamaCare. But they did, because of leverage, because of legislative shenanigans, because--and I'll say it, Mr. Speaker, that to understand this, that ObamaCare, for a long time here in the House of Representatives, was H.R. 3200, a bill that came through the Energy and Commerce Committee in a fashion that was, at least envisioned, to be a functional fashion through our Constitution and by our Founding Fathers. But it came through, and there were long, long debates in committee, but H.R. 3200, which was the product of the House, didn't make it to the floor for a vote.

What came to the floor for a vote under ObamaCare was a bill that was written in Speaker Pelosi's office of 2,600 or so pages, plus or minus 100. It depends on the font type. But 2,600 or so pages of a bill that no, not one person had an opportunity to read it all before it came to the floor for a vote. And as much as it was studied by many, there are quite a few Americans now that have read it all.

But, Mr. Speaker, I'll submit this, that it has so many convoluted contraptions within it, that there isn't a single person on the planet, no matter how intellectual they might be, no matter how much experience they might have, there's not one person that has the capability of reading the ObamaCare bill and understanding all of the activities of that bill where it references other sections of the code and you have to read it and switch back and forth, zigzag in and out of existing code and look at the ObamaCare piece of legislation and, at the same time, understand the implications to Americans. It's one thing to understand what a bill does technically, and it's another to understand how people have to live underneath that legislation. So H.R. 3200 kicked off to the side. The product of the actual committee didn't come to the floor. The product of the Speaker's office, her staff, many of them young, junior people writing up a bill that they thought was right for America, dumped down on us here to be on a short period of debate and a vote be passed by the House, and could not and would not have passed the House the day it was brought to the floor for a vote except for a couple of little promises. One of those promises was that the Senate would pass a reconciliation package, which put other pieces into it in order to avoid the filibuster rule in the Senate. So in order to get that done, they had to bring some things that couldn't get passed under the filibuster rule in the Senate, write them up in a separate bill. Well, somehow that bill couldn't have been amended to the one here on the floor because that wouldn't have passed. And furthermore, the ObamaCare bill that was written in Nancy Pelosi's office couldn't have passed here on the floor because Bart Stupak had a dozen Democrats that locked up with the Republicans and said, we aren't going to vote for a bill that funds abortion. Nancy Pelosi wrote a bill that funds abortion. Harry Reid wrote a reconciliation package that they promised to send over to the House that did the things that his Senators needed to have happen and that House Members needed to have happen, and the piece of ObamaCare that was written by Nancy Pelosi that funds abortion was going to satisfy the Stupak dozen if the President signed an Executive order that amended the legislation that was before the House.

Now, Mr. Speaker, I wouldn't expect every American to be completely understanding this convoluted process. In fact, I'd expect most of them to be very confused about this. This was designed to be a confusing process. And the idea, the very idea that the President of the United States would take an oath of office to preserve, protect, and defend the Constitution of the United States, that everybody in this Chamber would do the same thing, and everybody in the Senate would do the same thing, and then believe somehow, all you have to do is read article I of the Constitution, and one can easily conclude that the President cannot amend a piece of legislation by signing an Executive order. He does not have the authority to do so. That is a constitutional violation.

And I have, in the very similar, if not exactly identical language that is in the Iowa Constitution, gone to court to prove exactly that when former Governor Vilsack thought that he could rewrite the code of Iowa by executive order. And the case of King v. Vilsack is in the books, Mr. Speaker, and the Court vacated the executive order of the Governor of the State of Iowa because he thought he could legislate by executive order. I said he couldn't. We went to court. The judge said he couldn't, and it's resolved in that issue, and the point is conceded by former Governor, now Secretary of Agriculture, Tom Vilsack.

That same tactic was used by the President of the United States, Barack Obama, when he signed an Executive order that was designed to amend the bill that was about to pass, actually he signed it after the bill passed. And the bill that passed on the condition that the President would sign an Executive order to take care of the funding for abortion and that the Senate would pass a reconciliation package that fit the other needs.

Why couldn't we do this under what we call here regular order? Why couldn't we have a committee process that would work a bill through?

Well, they did, but Nancy Pelosi dropped that one in the trash, wrote her own. Why couldn't they allow the reconciliation package, if it had any merit, to be amended on to the ObamaCare legislation, even if it's the legislation that was written in Speaker Pelosi's office, and rejected that out of committee? Why couldn't that have been an amendment that could have been voted on up or down here in the House of Representatives attached to the same piece of legislation?

Why couldn't they have put the language of Barack Obama's Executive order that supposedly says the Federal Government's not going to fund abortion. Why couldn't they have put that into the bill too and had an honest debate on an honest piece of legislation? Why not?

Well, because it wasn't. Because they could not pass it under an honest process. It had to be a legislative shenanigans process. That's what we got.

And as that bill went to final passage that night, I got a little bit of sleep that night, not much. I drafted legislation to repeal ObamaCare. Probably at the same time, me not knowing it, Congresswoman Michele Bachmann of Minnesota drafted legislation to repeal ObamaCare. We each got our legislation drafts down and they came to us shortly after 9 o'clock that morning, exactly the same 40 words, within 3 minutes of each other, that said we're going to--now, I'm going to do this a little bit in summary, but only 40 words--that this Congress would repeal the act of ObamaCare. And it references the two sections that are the components by number, by bill number, and the last words of that repeal bill is as if it had never been enacted.

So we introduced that legislation, actually separately. I joined on hers and she on mine, and we went to work to get signatures to move the repeal bill. That turned into a discharge petition with 173 signatures on it, and that would be throughout the summer and into the fall of last year that we were getting signatures on the discharge petition.

And Mr. Speaker, you will know that if there's 218 signatures, a majority of the House of Representatives on a discharge petition that represents a bill, that bill bypasses committee, and the Speaker can't block it, and it comes to the floor to be voted up or down without amendment. That's what a discharge petition does.

Well, it took us a long ways down the line of a commitment to repeal ObamaCare, and it was a tool that was used by several, and I'll say many candidates for Congress who now, some of them elected to this Congress, part of the 87 freshmen Republicans, all of whom ran on the repeal of ObamaCare. And I believe, and don't know this, and I've heard no exceptions, but I believe it's also likely that all of them ran on defunding ObamaCare, cutting the funding off, because we knew that a Republican majority here in the House could pass the repeal of ObamaCare, which we did in the second week here, under H.R. 2.

The second highest priority for Speaker Boehner was the repeal of ObamaCare. H.R. 1 was funding the government; H.R. 2 was repealing ObamaCare.

That legislation passed the House with a resounding solid bipartisan vote and went over to the Senate, where every Republican in the Senate voted to repeal ObamaCare.

We committed to cutting off the funding to ObamaCare, and that's the next step. And I said, since last July at least, to cut off all the funding to ObamaCare in every appropriations bill that comes out of the House of Representatives.

Well, H.R. 1 was the single piece of legislation where we had the maximum amount of leverage. That is the funding for the duration of the year for all of the functions of government.

We learned sometime last year that there were automatic appropriations

deceptively, I believe, written into ObamaCare that are designed to create this perpetual money machine that funds the implementation of ObamaCare. Some call it mandatory spending. I do not. I call it automatic spending. There is automatic spending in ObamaCare written into it. And the number is still on my hand in Sarah Palin fashion, $105.5 billion automatically appropriated, spent in an authorization bill completely outside of regular order of this Congress, with a handful of exceptions, in short term and few dollars. But in scope and in magnitude, no one has ever tried, no one has ever had the audacity to try to impose an automatic appropriation on this Congress that would be $105 billion.

Some of that money goes beyond that. That is just 10 years. Some of it is appropriated, Mr. Speaker, in perpetuity; $1 billion a year here and $1 billion there that goes on every year that can't be stopped unless Congress goes in and shuts it off. And that is what we need to do, Mr. Speaker. We need to do this in every bill.

This continuing resolution that is before us now must include within it the language that cuts off the funding to ObamaCare, the current and the previous, the language that cuts off the automatic spending in ObamaCare.

There is $18.6 billion for fiscal year 2010, most of it not spent yet, that implements ObamaCare, $18.6 billion of the $105.5 billion, and there is another $4.95 billion in 2011 that automatically appropriates to ObamaCare. That is $23.6 billion, Mr. Speaker, that goes in to kick ObamaCare in. It has been found unconstitutional by two Federal courts, and it has been rejected by the American people who sent 87 freshmen Republicans here to repeal ObamaCare, and we are sitting here looking at $23.6 billion in automatic spending. We are struggling to cut the budget by $61.5 billion. Well, let's do that. But over here is $23.6 billion in automatic spending that goes on.

And if, as I believe, Harry Reid is committed to shutting our government down--and by the way, the majority leader in the United States Senate speaks, I think, as a proxy for the President. What does the President want here? Well, he wants to delay, or he would be telling Harry Reid to pass something. And I believe Harry Reid wants to delay and then shut down.

They have convinced me that their intention all along was to shut down this government. That is why they agreed to a short-term continuing resolution until March 4, so they could posture themselves to be in a position to force a shutdown of the government. They think that they can blame it on Republicans, and then the public will punish Republicans at the polls.

Well, Mr. Speaker, I will submit that is not the way it is and not the way it will be now, because John Boehner and Eric Cantor's leadership have demonstrated clearly that this majority in this Congress, the Speaker's office, the majority leader's office down the line have three times--H.R. 1, 2-week CR, 3-week CR--demonstrated there are the dollars for the legitimate functions of government. There are the dollars for it. We have provided it three times here, and three times the Senate hasn't moved on anything of their own initiative.

So they have convinced me that their goal all along was to shut down the government. And if I didn't believe that, all I had to do was listen to Senator Schumer or Howard Dean or some of the language coming out of Majority Leader Reid. I am convinced that they are committed to shutting this government down.

If they do that, we need to say to them: Here are all the resources, again, and no money to implement ObamaCare.

If there is no money to implement ObamaCare but all the money that is necessary for other fiscally responsible, legitimate functions of government and they go in and shut this government down and point their fingers at us, the American people will know differently. They will understand that it always was the strategy to shut the government down by the Democrats in the Senate, and the White House, and that we are committed to keeping it open. But we cannot be allowing the funding to go forward to an unconstitutional taking of American liberty, which is ObamaCare on its face.

It is unconstitutional in four different ways: It is irresponsible; it is unsustainable; it can't be funded; and we can't find the funds to fund it all. It is $2.6 trillion in outlays in the first 10 years.

We must, Mr. Speaker, cut off the automatic funding to ObamaCare, and any funding going forward to ObamaCare let the courts decide. And we decide here in the House of Representatives to draw a line, draw a bright line and stand firm. That all needs to happen in that way.

And history tells us this, Mr. Speaker: That when there was a government shutdown, the argument last time was over spending, most of it within either Medicare or Medicaid. If my memory serves me correctly, it was over $300 billion in cuts. Whether it would be a plus-up or a plus-down from that, you can't take a stand on a money figure. You can't say, I'm going to stand and fight on $300 billion. But if they lower my cuts down to $299 billion, I'm going to be a ``no.'' Or, if they take it up to $301 billion, I will be happier yet. You cannot stand on a principle that is a dollar figure, because whatever you pick it is always going to be on a sliding scale. It is not a principle.

We are standing on $61.25 billion right now. Well, if they lower those cuts down to $61 billion, do we say ``no''? I think that the Democrats on the other side understand that. That is why they have floated this number of $33 billion in cuts. They haven't said whether they were willing to accept it yet.

They got to $33 billion in cuts this way: They took $61.5 billion, divided it by two, and rounded it up to $33 billion. That is how they arrived at the number. There isn't any question in my mind about that. And they want to be able to say, well, we met you halfway and a little more, so you should be happy that we are willing to compromise. To them, compromise is: Take the number, cut it in half, and then, if you can't get agreement, cut it in half again. And they call it compromise.

Well, I have said money itself is not a principle. You can't stand on something strongly unless you are standing on a principle. Well, a principle is an unconstitutional 2,600-page taking of American liberty, the nationalization of our skin and everything inside it called ObamaCare. That is a principle.

It is completely unsuitable for an American people that live with the liberty and freedom that God gave us, that our Founding Fathers so well articulated in the Declaration and in the Constitution, that is part of our tradition, part of our history, and part of the inspiration for the entire globe to be knocking on the door wanting to come to the United States of America. Because of what? Liberty, Mr. Speaker, listed out in the Bill of Rights: Freedom of speech, religion, and the press. Freedom to peaceably assemble, and petition the government for redress of grievances. The Second Amendment, to keep and bear arms. The right to own property. Protection from double jeopardy. To be tried by a jury of your peers. The philosophy of Federalism that devolves the powers down to the States or the people respectively. All of this and going on. Equal protection under the law and the 14th Amendment. On and on and on.

These are the inspirations for a vigorous people, a people that have a belief and a common cause and a common culture, a cultural continuity of belief in our liberty.

And they would impose us, what? Socialized medicine? A Federal taking of our right to manage our own health care? And part of that management would be to buy a health insurance policy that is driven by the marketplace that people demand and want? That would have any of the bells and whistles that the market demands and have every bell and whistle that the market demands, and should not have mandates imposed on it by the Federal Government that are imposed within the States.

People should be able to buy their own health insurance policy across State lines. The protection for the monopolies of State health insurance companies is anti-market, it is anti-free market, it is anti- freedom. And John Shadegg's bill that he pushed so hard while he was here needs to be something that goes to the President's desk, that allows people to buy insurance across State lines; so that a

young man 23 years old paying $6,000 a year for a typical policy in New Jersey, laden with mandates, could instead go buy that typical policy in Kentucky for not $6,000 but $1,000. Doesn't that help our costs? Doesn't that get more people insured? Doesn't that do the right thing and protect people?

That is just one. I could take you down through a list of seven or eight or nine good solid Republican ideas, most, if not all, of which can come to this floor as standalone pieces of legislation and be sent over to the Senate, where Harry Reid would push them off his desk into the trash can. They wouldn't have the respect of going in his desk drawer.

Why? Because they are liberty oriented; they are free market oriented; they are constitutional; they are principled, and it gives people back their liberty.

But this country, the United States of America, this vigorous people that we are, we have a vitality that is unique. We have all of the vitality that comes from the rights that I have talked about. We have the vitality of the free enterprise system, which is the foundation of our economic system.

I would point out that there are flashcards that newly arriving immigrants, or those, I should say, that are studying for their citizenship test, mostly that is 5 years in, studying for their citizenship test, flashcards. On one side it will say, Who is the father of our country? You snap it over, it says, George Washington. Next card, Who emancipated the slaves? Snap that card over, Abraham Lincoln. Next card, What is the economic system of the United States of America? Free enterprise capitalism. That is an axiom of faith of the American people, that we are free to spend our money as we choose.

ObamaCare commandeers our paycheck, Mr. Speaker. It takes it over. And they say you must buy this health insurance policy that is approved or produced by the Federal Government, and if you don't do that, we are going to send the IRS in to punish you, to fine you. It is a punishment if you don't buy it.

If they can pass a law that requires you to buy a product that is produced or approved by the Federal Government, if they can commandeer 5 percent or 10 percent, or in many cases 25 or 40 or even 50 percent of your payroll to pay for a health insurance premium, if they can commandeer any part of your earnings and force you to buy something, the next step is they can commandeer your money to buy a General Motors car because their investment may not be doing so well, or a Chrysler. Or maybe you could buy some shares of Fannie Mae and Freddie Mac. They took that over, too, didn't they? Maybe they can force you to invest in the student loan program. They took that over, too, didn't they? They could force you to buy a certain kind of washing machine, a certain kind of shoes. And they can also force you, at that point, you have to buy so much diet pop instead of non-diet pop, so many ratios of carrots versus candy bars.

If they can commandeer 1 percent of your paycheck and force you to buy a product, they can commandeer 100 percent of your paycheck and force you to buy all products, to the point where you are enslaved by the Federal Government. How can that be constitutional for a free people?

Mr. Speaker, I will submit it is not and it cannot be, and that is why this House voted resoundingly to repeal ObamaCare. That is why every Republican here and in the Senate voted to repeal ObamaCare. That is why we must cut off all funding to implement or enforce ObamaCare in every appropriations bill, and that is why they deceptively plugged into ObamaCare the automatic appropriations of $105.5 billion, and that is why they front-loaded it with $18.6 billion in the FY 2010 budget to intensively implement ObamaCare, and that is why there is another $4.59 billion in this fiscal year. There is $23.6 billion sitting there in the pot.

And think of this, Mr. Speaker. If they are successful in forcing a shutdown of this government, and while they are busily trying to point their fingers at those of us who provide the resources to keep it open, we would still see $23.6 billion hard at work implementing ObamaCare. The lights could go off in Federal offices all over America because of a shutdown, but you could drive down and look at where the lights are on. Guess what? That is the $23.6 billion still there, still implementing ObamaCare, like Santa's little elves, making sure we have socialized medicine before the lights come back on.

That is what we are faced with, Mr. Speaker. That is where we must draw a line. We must stand and do this fight. The fight is inevitable. So choose the ground when the army is the strongest and on the ground that we can stand and fight on, and that is this: Provide the resources for the legitimate functions of this government, not for the illegitimate functions of this government. And if the President of the United States working through his mouthpiece, Harry Reid, or directly brings about a shutdown, it will be about a bright line between all of the legitimate functions of government versus perhaps a legislative tantrum, an act of audacity and narcissism that his signature piece of legislation called ObamaCare means more to the President of the United States than all of the functions of government put together, Mr. Speaker.

For all those reasons, I say, this is the week to draw the line. This is the week to do the fight. This is the week to do the battle. We have to have it. We can't avoid it. Let's get it over with so we can get on with the legitimate functions of the United States Government.

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.

I yield myself such time as I may consume.

Mr. Chairman, I rise today in support of H.R. 1216.

The health care bill that was signed into law last year spent over a trillion dollars and empowered Federal bureaucrats more than it did the American

people. As a member of the Energy and Commerce Committee, I have been working on legislation that takes steps to peel back a few of the many mandatory programs that were instituted in the health care law and limit the Federal Government's unprecedented power.

Section 5508 of the health care law authorizes the Health and Human Services Secretary to award teaching health centers development grants and appropriates $230 million from 2011 through 2015. H.R. 1216 amends the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from direct appropriations to an authorization of appropriations.

This bill is not about the merits of graduate medical education or teaching health centers.

Everyone agrees that there is a strong need for more primary care physicians in our health care system, but picking and choosing one program over another to receive automatic funding is irresponsible. Making these programs mandatory spending is unfair to all of the other health care programs that have to compete every year to continue to receive funds.

For example, as HHS Secretary Kathleen Sebelius said during her testimony before the House Energy and Commerce Committee earlier this year, the President's fiscal year 2012 budget eliminates Graduate Medical Education for Children's Hospitals. While children's hospitals must go through the regular appropriations process to fight for funding, teaching health centers will receive automatic appropriations.

We are $14.3 trillion in debt, and our deficit for this year will approach $1.5 trillion. Congress is making difficult decisions about which programs to fund and which to reduce. We must prioritize, and I find it unfair that some programs are completely shielded and do not have to prove their merit to earn continued funding.

I urge my colleagues to vote ``yes.''

I reserve the balance of my time.

Mr. Chairman, I yield 2 minutes to the gentleman from Pennsylvania (Mr. Pitts), the chairman of the subcommittee.

Mr. Chairman, I yield 4 minutes to my friend from Tennessee (Mrs. Blackburn).

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

First there were a number of amendments, I think over 100 amendments, to the health care bill that were offered by the Republicans. An alternative was offered by the Republicans as voted on as we went forward.

Block grants, several Governors have come to Washington and talked about

block granting Medicaid to give them the opportunity to not just deal with Medicaid in their States but there was the other part of their budget.

But I can tell in Kentucky, because I used to be a member of the State legislature, as Medicaid has continued to consume more of the State budget, it becomes more difficult to adequately fund. Higher education tuition rates are going up directly because of the pie of Medicaid that's moving forward.

We passed medical liability reform, which saves the Federal Government $54 billion, as estimated by the Congressional Budget Office. We are going to have the bill tomorrow to purchase health insurance across State lines to make health insurance more affordable instead of more expensive on those who spend money out of their own pocket, as we have seen the estimates for the health care bill.

Now, the one thing about relying on funding for 1 year, we do appropriations for everything from defense to other things on an annual basis. And I will tell you there are not people turning down Federal money because you are only appropriating it for 1 year, we don't want to commit to a long-term program.

But if you buy that argument, you look at what's in the bill. All we are saying is we want the teaching health centers to be treated equally to other parts of the bill. So if the argument is if you don't do it automatically, you are not going to have anybody participating in the program, which I think is what I just heard, then it means training in general in pediatric and public health dentistry, section 5303, is an annual appropriation; geriatric education and training, mental and behavioral health education training; nurse retention, section 5309; section 5316, family nurse practitioner training; section 2821, epidemiology laboratory capacity grants; research and treatment for pain care management, 4305; section 775 investment in tomorrow's pediatric health care workforce.

I mean, obviously, the argument that was made was if we don't have the teaching health centers on a 5-year automatic appropriation, then people aren't going to participate in the program. That argument would have to apply to these directly. And I guarantee you, I would be willing to say, without fear of contradiction, that people will be applying for these programs as this moves forward.

I reserve the balance of my time.

Mr. Chairman, I yield myself 1 minute.

The merits of having training in general in pediatric and public health dentistry, I agree that we have to have that training. The issue here is if you do it in a teaching health center, then you guarantee funding for 5 years. If you do it in a children's hospital, if you do it in a regular hospital, profit or nonprofit, then you are subject to the annual appropriations.

Someone came before our committee to testify, a State Senator from New Jersey, said we need this provision because we need more nurses.

I will agree with that. However, this provision doesn't cover nurses. If you are going through a nurse training program, it's authorized in the bill, and you go through an annual appropriations process.

All we are saying here is that we should treat graduate medical education at children's hospitals, hospitals and teaching health centers exactly the same and not give one an advantage over the other two.

I reserve the balance of my time.

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

Mr. Chairman, I yield 2 minutes to the gentleman from California (Mr. Bilbray).

Mr. Chairman, I yield an additional 2 minutes to the gentleman from California (Mr. Bilbray).

I yield the gentleman 1 additional minute.

Mr. Chair, I yield myself as much time as I may consume.

I want to point out, as we went through, what we're talking about doing is graduate medical education in teaching health centers will be identical to the graduate medical education in hospitals and children's hospitals.

And I remember, I was not on the Energy and Commerce Committee but in Education and Labor. We worked on the health care bill. And the description that we went in through the night and went through the bill line by line is absolutely true. I think we were 24 or 25 hours direct on that. And I wasn't on Energy and Commerce when you went, but they went through the night, as well, Mr. Chairman. And when this bill passed out of the House of Representatives, the teaching health centers were authorized subject to appropriation.

The change was made in the Senate. So working late into the night and going through the bill, we are just asking and what we are proposing is to treat teaching health centers as the House-passed version of the health care bill did, which is exactly the same as hospitals and children's hospitals and many of the other programs, nurse training and other things as well.

I reserve the balance of my time.

Mr. Chairman, I want to point out again, the mandatory spending was not in the House version of the health care bill that was passed. Teaching health centers were treated exactly like general pediatric and primary care physicians are in hospital settings and in children's hospital settings--general hospitals and children's hospitals. We are saying we are going back to the way it was established in the Affordable Care Act as it was passed out of the House of Representatives.

We are talking about primary care physicians as well. I agree we need more primary care physicians. Their training at children's hospitals and hospitals is in geriatric, pediatric, internal medicine, all the primary care physician specialties that we know. We are just saying one shouldn't be treated differently than the other. They are important, and we should go through the annual appropriations process and present the validity of programs and let the appropriations process determine the level of funding.

Mr. Chairman, I yield 4 minutes to the gentleman from Georgia (Mr. Gingrey).

Again, Mr. Chairman, it is important that we have an adequate supply of primary care physicians, and it is important public policy for this country. It is important that we also have oversight and control over the budget in the way the money is spent, and we do that through the appropriations process.

I just want to point out, in the last Congress, there was great effort in putting together the health care bill. When we passed out of this Congress the House-passed version, this was an authorized ``subject to appropriations'' section of the bill. I know it has been described as being against health care throughout the country, but that was the way, through much debate, it passed out of this House of Representatives. It treats it similarly to hospital-based education in primary care and to children's hospital-based. It puts it on an equal footing with nurses' programs, nurse practitioner programs and other programs, which we all agree have shortages. We need more people in those fields.

I just want to reiterate that this does not eliminate the program. It authorizes it. It changes it from a direct appropriation to an authorized appropriation through the regular appropriations process.

I yield back the balance of my time.

Mr. Chairman, I rise in opposition to the amendment.

Mr. Chairman, first, I want to point out the list that was read of teaching health centers.

The text of the bill is very clear: that we only rescind unobligated funding. If the funding has been obligated, then it continues to move forward. So, as to the list that was read, those will be funded.

The amendment before us directs the GAO to determine the number of physicians who will be trained by this program if funds are not kept mandatory. I oppose the general premise that a program must have mandatory funding in order to be effective. This type of thinking has led us to massive budget deficits as far as the eye can see.

During the debate on the continuing resolution, I can remember more than a few Members complaining that reductions in discretionary spending would have little impact on the deficit. There is some truth to the fact that discretionary spending which Congress has more control over comprises an increasingly smaller share of the Federal budget.

It seems to me that some people's solutions to reining in the discretionary ledger of our Federal budget is to simply shift programs from discretionary to mandatory and let the spending cruise on auto pilot. That is not responsible governing. In a time of $1.5 trillion annual deficits, we must make spending priorities. However, setting priorities involves tough choices. The people that oppose this bill do so because they are unwilling to make the tough choices on what programs the Federal Government should fund and what they should not.

So let's review what happened. Certain programs for training were made mandatory in the health care act and others were subject to future appropriations. Listening to the debate today, it is apparent that some believe any provision in the health care act that authorized a program subject to appropriations is essentially meaningless and did nothing at all. I have heard Members extol the virtues of dental education programs or training for nurse education contained in the health care act, but they are subject to further appropriations.

Where was the amendment to the health reform bill that asked GAO to look into how the lack of mandatory spending in section 5305 of the health care act would affect geriatric education? There wasn't one, and not a single Member of the other side brought the issue up. The reason the other side didn't bring it up is because the programs were constructed in a way to go through the normal authorization and appropriations process. The underlying bill simply puts teaching health centers on equal footing with a myriad of other programs.

I also oppose the amendment because it is a waste of Federal resources. We are asking the GAO to conduct a study that is almost impossible for it to complete. The GAO cannot determine the number of physicians that will be trained because so much of the program is under the discretion of the Secretary. In fact, the contours of the program have not yet even been set. The Health Resources and Services Administration does not even anticipate issuing a Notice of Proposed Rulemaking on the Teaching Health Center Graduate Medical Education Program until December.

Under my bill, supporters of the program will continue to be able to make the case on an annual basis that the program is not duplicative, it is effective, and warrants continued funding over other programs like children's hospitals which the President's budget zeroed out.

I urge my colleagues to vote ``no.''

I yield back the balance of my time.

Mr. Chairman, I move to strike the last word.

Mr. Chairman, this amendment is very similar to the previous amendment we discussed, so I will be brief.

One, as I said before, it is difficult for the Government Accountability Office--almost impossible for them--to perform this study moving forward because there is so much discretion that is given to the Health and Human Services Secretary. And as I said before, the Health Resources and Service Administration does not even anticipate issuing a Notice of Proposed Rulemaking on teaching health graduate centers until December.

And then again, as a lot of the comments today, I don't think that moving an authorized and mandatory spending program to an authorized and discretionary spending program renders that program meaningless. If it does do that, then all the other programs that I have listed earlier in the debate--training in general hospitals, training in children's hospitals, training in behavioral education and health, training in nurse retention, training in nurse practitioners--that means that those programs that were in the health care act would not have as much strength as well. And so the comment that by moving this from one part of the budget to the other makes it meaningless, to me, is just not accurate.

And, second, I also want to stress again that the language of the bill is clear: we do not rescind obligated funds; it is only unobligated funds. So again, it wasn't my friend from California, but someone earlier mentioned that there were programs that have already been in place that would be hurt by that. If the funds have been obligated, those programs move forward.

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

Madam Chair, I move to strike the last word.

I rise in support of the Foxx amendment. We have been debating the bill throughout the day, and I support the bill.

I just want to comment, I was also back home last week, and I went to a 100th birthday party for a group of people in northern Kentucky in the Louisville area and part of my district who were turning 100 years old. There was a lady there who was 103. She was born during Teddy Roosevelt's Presidency. I went there to thank them. I am one who is a big believer in what the Greatest Generation has done for us. I am a member of the baby boom generation. I was born in 1964. I am 47 years old. From 1946 to 1964, if you were born in 1946, you are in Medicare this year; you are 65 years old. I wanted to thank them and let them know that what we are doing is making a sustained and secure Medicare system for them.

We all know as of the end of last week that 2024 is the date put out that Medicare goes bankrupt. So what we have put together is a real proposal for 10 years to allow people the opportunity to adjust that are 54 and younger because there is not a member of the Greatest Generation--and if anybody says different they are wrong--there is not a member of the Greatest Generation that is affected. As a matter of fact, half the baby boomers are covered, are not affected by the changes that we have to make to make a secure and better future.

I am 47 years old. This means a lot to me because my daughter is 17. And you ask a lot of people my age: Do we have a better life-style than our parents had? Well, the Greatest Generation gave us a better life- style than they had because they wanted us to have a better life-style than they had. You ask a lot of people my age: Do we think our children will have a better life-style? It is amazing and it is disappointing to think how many people think that our children are not going to have the same quality of life that we had.

I didn't come to Washington, D.C. to be part of a government that doesn't address the fact that we want our children to have a better future than we had. In 30 years when my daughter is my age--she graduates from high school in 2 weeks--we can pay off the national debt.

So think about it. I am 47 years old. We have got a $14.3 trillion debt. You ask a lot of people my age: Do you think our children will have a better future? A lot of people say ``no'' because they say we keep piling on debt and deficits as far as the eye can see.

Madam Chair, if you ask me now if I thought my daughter at 47 years old is living in a country with zero national debt, do you think my children, grandchildren and her grandchildren will have a better future, they will. That is what we are talking about. We are talking about saving and securing Medicare for the Greatest Generation. We are talking about saving and securing it for people as they become older and more mature.

So anybody that says the Greatest Generation is affected by this is just not saying what was passed out of the House of Representatives. If anybody is saying that seniors are affected by this, they are not saying what was passed out of the House of Representatives. To say that we have to reform the program to make it stronger and better for them, that is accurate. And making it stronger and better for those who come forward, that is what we are talking about doing. That is what the facts are.

People deserve the facts. People are tired of hearing rhetoric. They want facts. And the facts are that we are sustaining and securing it for the Greatest Generation, and reforming it so it will be there as our children mature. And if we pass the budget, if the Senate would pass the budget that we passed out of the House, when my daughter is my age, we will have zero national debt, and we will have a better future. And then ask her if she thinks her children will have a better future than she did, and I guarantee you that she will say that.

I yield myself such time as I may consume.

Mr. Chairman, I rise today in strong opposition to H.R. 1216, legislation to convert mandatory funding authorized under the Affordable Care Act for Teaching Health Centers to authorized funding.

The Affordable Care Act authorized and appropriated $230 million for a 5-year payment program to support accredited primary care residency training operated by community-based entities, including community- based health centers. This training takes place in community-based settings such as community health centers.

Research shows that CHC-trained physicians, for example, are more than twice as likely as their non-CHC-trained counterparts to work in underserved areas, ensuring that that kind of training takes place, which is what mandatory spending support for programs does. It will help strengthen the primary care workforce in underserved areas, particularly in areas that struggle to recruit and retain a sufficient workforce.

The Teaching Health Center program supports the training of individuals who will practice family medicine, internal medicine, pediatrics, internal medicine pediatrics, obstetrics and gynecology, psychiatry, general dentistry, pediatric dentistry, and geriatrics-- those disciplines where we're experiencing significant physician shortages.

It's hypocritical for my Republican colleagues to take away this funding. They continue to argue that there are not enough physicians to provide care to people who need them in primary care services. This program is designed to help address this very problem. But they keep trying to have it both ways in health reform debate, and this is just another example.

Today, the majority is going to say they have an obligation to ensure this program is subject to the appropriations process due to the need for transparency in our spending process and current budget process. Let me remind the majority that we're not the only party who's directed mandatory funding for programs. The majority must have certainly supported autopilot spending, as Representative Foxx described the Teaching Health Center program earlier this afternoon, when they passed the Medicare Modernization Act of 2003, which required mandatory funding for transitional programs. I suppose at that time, the majority certainly felt they knew better than the appropriators that the MMA was a worthy program and deserved mandatory funding, even though they passed it under the cover of night with a lot of arm-twisting.

I can't understand the opposition, particularly from my Republican colleagues. They repeatedly and inaccurately complain that we don't do enough to promote health workforce expansions, and now they're going to cut funding for the health workforce expansion.

Turning the Health Center program into a discretionary one will make it challenging for these 11 programs that have already made the decision to participate in consultation with key stakeholders, like teaching hospitals and their boards, and based on the expectation that continued funding will be available. Converting this program to discretionary funding will also deter other entities from making the business decision necessary to expand residency training, since funding over the next few years could be subject to the annual appropriations fight.

This is yet another political stunt by the majority to attempt to defund health reform--this, through their playing games with funds dedicated to ensure that we have physicians in our country.

Several weeks ago, they couldn't stop talking about how Medicaid will be greatly improved with the Ryan budget because it provides States with block grants to run their Medicaid programs. How great would it be to eliminate Medicare by giving seniors vouchers to purchase health insurance? And this week, we're busy taking away funds to ensure that we train enough physicians to ensure all Americans have access to affordable care. Once again, the majority has their own priorities.

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

Mr. Chairman, I yield 2 minutes to my colleague from the Energy and Commerce Committee, the gentlewoman from California (Mrs. Capps).

Mr. Chairman, I gladly yield 3 minutes to our ranking member of the full Energy and Commerce Committee, the gentleman from California (Mr. Waxman).

Mr. Chairman, I yield 2 minutes to a classmate and also the vice chair of our Democratic Caucus, the gentleman from California (Mr. Becerra).

Mr. Chairman, I yield myself 15 seconds.

I will be glad to cosponsor the bill to make it mandatory funding for children's hospitals. I think if health care is a priority, we ought to do that.

I reserve the balance of my time.

Mr. Chairman, how much time remains on each side?

I yield myself such time as I may consume.

When Congress dealt with The Affordable Care Act last year and the year before, our subcommittee on Energy and Commerce spent exhaustive hearings, late-night hearings, we had markups overnight, and so we knew what we were doing. We knew we were going to make a priority in providing primary care for our country.

That's why it's mandatory spending. I would assume in 2003, when we passed the provision for the prescription drug act for Medicare, my Republican colleagues did the same thing at the time in the majority: they wanted to make sure that that was mandatory spending.

And here we are today trying to take away mandatory spending from primary care physicians in community-based settings. I have a great example of this in our own district, and I know the chairman knows this.

We have a community-based health center in Denver Harbor in east Harris County. They have had a partnership with the Baylor College of Medicine for a number of years, and what they have been able to do is provide those residencies to come out to a nonwealthy area of town so those doctors can learn that they can make a living serving folks that are not wealthy. That's what this is all about. We found out that the statistics showed that if they do their residency through a community- based health center, they will actually be more likely to come back and serve those communities. And that's why there needs to be mandatory spending, Mr. Chairman.

I reserve the balance of my time.

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

My colleague from California must have this bill confused with medical malpractice. In fact, the State of California and the State of Texas already have medical malpractice reform. That's not what this bill is about. This bill is about training primary care physicians to be able to serve everyone. I want them to serve the military. I want them to serve our veterans.

In fact, again, I have a VA hospital in Houston that has a cooperative arrangement with the Baylor College of Medicine for a residency program. That's great. I want them also to be able to do that in their clinics. But I also want it for community-based health centers. And our statistics show us that if we have that example and it's mandatory spending that they make these agreements, that those folks will come back. They may go back to a military clinic, they may come back to a community-based health center, or they may come back and open up their practice in an area that's not the wealthiest part of town. That's why this mandatory legislation is so important.

If you put a priority on making sure our constituents can go see a doctor, I can't imagine repealing this--voting for this bill.

I reserve the balance of my time.

Will the gentleman yield?

I thank the gentleman for yielding.

Again, this is not a medical malpractice bill, but I would be glad to offer you to be a cosponsor. We passed the bill out of this House twice and sent it to the Senate which would allow volunteers to go into community-based health centers and be covered under the Federal Tort Claims Act. Congressman Murphy from Pennsylvania is a lead sponsor of this Congress. I've been the lead sponsor when Democrats have been in control because we need to do that. If I could do it under this bill, I would do it. But this came out of your conference that you want to repeal mandatory spending to try and train primary care doctors to serve in primary care clinics or whatever.

Mr. Chairman, my colleague from California again is confused. We have H.R. 5 that the majority has to federalize medical malpractice insurance in our country. Some States have taken care of it. The State of Texas has done it by constitutional amendment. And that debate may come up if the majority brings up their H.R. 5.

With that, Mr. Chairman, I yield 2 minutes to my colleague from New York, Congressman Tonko.

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

I have no problem with including children's hospitals , and I think we could probably pass it on the suspension calendar if we had legislation that would expand that mandatory funding for teaching hospitals, and particularly children's hospitals, but that is not what this legislation does today. It takes away that help we are providing to train more primary care physicians in our country. That is what this bill does: It takes away the mandatory funding.

Now there have been examples all through history of mandatory funding. We realized during the Affordable Care Act that we need more primary care physicians. We need a lot more health care providers. We need more nurses. We need everything. In fact, it is a great job growth area. But we know we need primary health care providers because we know when somebody needs a doctor, they will see that primary care doctor. They may need a specialist, but they still need to go to that primary care doctor. That is why this mandatory funding is so important, and that is why this bill is the wrong way to deal with it. That is why it shouldn't be considered today. I would hope everybody would realize that if you support health care and primary care physicians, you would want that mandatory training so we can get those physicians out in the community where they are really needed.

Numbers show that if we have a program like this where primary care physicians will go into a community based health care center, they will go into that area as part of their residency program, they are more likely to come back to that community. That is why that was part of the Health Care Act. We have people who their primary care physicians now are the emergency rooms in hospitals in my district. I would much rather they be able to go see a doctor down the street for their sinus infection than showing up at midnight in an emergency room where we are going to end up having to pay for it, even at a public hospital, where the local taxpayers are paying for it. That is why this mandatory spending is so important. And that is why I think it is so the wrong way to go in health care, to take away mandatory spending for primary care physicians. That is something that is so important in our country, it should be mandatory.

I reserve the balance of my time.

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

Let me correct some of the statements that have been made. We have had mandatory hospital training residency programs since 1965. By taking away direct or mandatory spending for community-based residency programs, it is a direct attack on community-based programs. Let me list for you the teaching hospital programs that are under mandatory that was part of the Affordable Care Act. I joked on the floor one night to my colleague from Georgia, I wish they would name it the Green Act, GreenCare instead of ObamaCare, because I am so proud of that law.

The teaching hospital program supports the training of individuals who practice in family medicine, internal medicine, pediatrics, internal medicine pediatrics, obstetrics, gynecology, psychiatry, general dentistry, pediatric dentistry, or geriatrics. These are disciplines where we are experiencing significant physician shortages. That is why we need the mandatory spending. It does cover children.

Now, we have had mandatory spending for hospital training, again, since 1965. All this bill would do would be to take it away from community-based health centers where we know there is a shortage. The statistics show, if you have doctors who do their residencies or residency programs through community-based centers, they are more likely to go back there and practice, whether they be pediatricians, whether they be in family practice, whether they be in internal medicine. That's where we need the growth and to have primary care physicians. This is a direct attack on health care in our own country.

Why wouldn't we want it mandatory for community-based facilities if it's already mandatory for hospital-trained physicians? We need physicians in the community, not just in the hospitals.

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

Mr. Chairman, I move to strike the last word.

Mr. Chairman and Members, I know there has been talk only about obligated money. I would like to introduce into the Record a press release issued on January 25 of this year from Health and Human Services announcing the new Teaching Health Center Graduate Medical Education Program. And of those programs, it lists the ones; and that money is obligated, but there will be no future funding for them. So you get a few months of funding, but you don't get any more funding.

These centers--six of them are in Republican districts, five in Democratic districts--will get a very short 3 months' worth of funding if this bill becomes law. And it doesn't do any good. The graduate medical education pays for the training of that physician. These community centers will only receive a short term funding. So it may only be talking about that obligated money, but they won't get any more after this year if this bill becomes law. That's why it is so important that this bill be defeated or that we adopt an amendment similar to our colleague from California.

HHS Announces New Teaching Health Centers Graduate Medical Education

Program

Eleven centers will support primary care residency training in

community-based settings

HHS Secretary Kathleen Sebelius today announced the

designation of 11 new Teaching Health Centers in the Teaching

Health Center Graduate Medical Education program, a 5-year

program that will support an increased number of primary care

medical and dental residents trained in community-based

settings across the country. These Teaching Health Centers

will be supported by funds made available through the

Affordable Care Act and will help address the need to train

primary care physicians and dentists in our nation's

communities.

With the funds, these Teaching Health Centers can seek

additional primary care residents through the National

Resident Matching program this month and will train 50

additional resident full-time equivalents beginning in July

2011. While 3 months of funding totaling $1,900,000 is being

awarded this first program year, in future years the annual

funding will increase to cover the full-year costs, as well

as additional residents. These investments provide an

important platform for expanding the primary care workforce

and creating more opportunities to prepare physicians to

practice primary care in community-based settings, while

ensuring primary care services are available to our nation's

most underserved communities.

``The Teaching Health Center program is an integral part of

our mission to strengthen the nation's primary care workforce

and ensure that all Americans have adequate access to care,''

said Secretary Sebelius.

The new Teaching Health Centers are distributed around the

nation and will train residents in family medicine, internal

medicine, and general dentistry. Teaching Health Centers will

receive up to 5 years of ongoing support for the costs

associated with training primary care physicians and

dentists. HHS' Health Resources and Services Administration

(HRSA) will administer the program.

``Participating in this program not only provides top-notch

training to primary care medical and dental residents, but

also motivates them to practice in underserved areas after

graduation,'' said HRSA Administrator Mary Wakefield, Ph.D.,

Madam Chair, I move to strike the last word.

First of all, I have utmost respect for Congresswoman Foxx of North Carolina. But her amendment is a solution in search of a problem. Graduate medical education does not do abortions.

The teaching hospital center program funds training for primary care residents. There is no payment for services in the law. It's about salaries, benefits, and paying faculty. Teaching health centers will pay for abortions no more than Medicare Graduate Medical Education has paid for abortions for the last 45 years.

The President signed the executive order to make all the provisions subject to the Hyde amendment, all the provisions of the Affordable Care Act subject to the Hyde amendment. The executive order establishes a set of policies for all provisions of the Affordable Care Act to ``ensure Federal funds are not used for abortion services'' consistent with the Hyde amendment. The Presidential order reinforces what we all agree on. No one is here claiming that we should use Federal funds for abortion, except in very limited circumstances, whether they are under this program or elsewhere.

There is another layer of protection codified in permanent law under section 245 of the Public Health Service Act. The Coats amendment clearly prohibits the Federal Government from discriminating against any physician, post-graduate physician training program, or participant in a program of training in the health care professions because the entity refuses to participate in abortion training. That's not an appropriations vehicle; it's not an executive order. It's the law of the land.

That's why I say this amendment is a solution in search of a problem. There is not a problem with Graduate Medical Education, whether they be teaching hospitals, whether they be community-based centers that this bill is subject to.

I yield back the balance of my time.

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.