Medicare Decisions Accountability Act of 2011

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

Today I come to the floor to speak in support of H.R. 5, the Protecting Access to Healthcare Act, which, among other things, will repeal yet another poorly designed provision from the Democrats' health care law.

Specifically, this legislation would repeal the Independent Payment Advisory Board. IPAB, as it's commonly known, is a dangerous new government agency made up of unelected bureaucrats who can meet in total secrecy to decide what seniors will pay and what health care services will be available to seniors. This unaccountable board has but one objective: to save money by restricting access to health care for Medicare beneficiaries.

Nearly 2 years since its passage, the Democrats' health care law remains deeply unpopular, with an Associated Press poll recently revealing that nearly half of the American people oppose the law. IPAB, which is a critical component of the law, illustrates why those concerns are still so strong.

A separate poll confirms that opposition far outweighs support with 73 percent expressing concern that Medicare cuts recommended by IPAB could go into effect without congressional approval. Even IPAB's recommendations overturn a law previously passed by Congress. Seventy- one percent expressed concern that changes made to Medicare based on IPAB's recommendations cannot be challenged in court, and 67 percent worry that IPAB could choose to limit which specific health services are covered by Medicare.

The American people have every reason to be worried. We should be protecting and empowering our seniors, not jeopardizing their access to health care. Yet IPAB removes seniors, physicians, and families from the decision-making process about how best to meet their health care needs. Instead of giving seniors more choices, these unelected bureaucrats will take away choices from patients, from doctors, and from families. This government-knows-best approach is why Americans across the country support repeal, and it's also why there's strong bipartisan support here in Congress to repeal IPAB.

When the Ways and Means Committee considered this legislation, we received numerous letters from groups across the Nation representing employers, patients, doctors, and health care professionals who voiced strong support for IPAB repeal. The groups span

across the political spectrum and include the Easter Seals, the Alliance of Specialty Medicine, the Veterans Health Council, FreedomWorks, and Americans for Tax Reform. In total, over 390 groups have signed letters asking that Congress repeal IPAB, and I will insert these letters into the Record.

America's seniors deserve better. Without reform, the Medicare trustees have said that Medicare will soon go broke and not be able to provide the benefits seniors rely on. With more and more Americans becoming eligible for Medicare each day, no time is more urgent than now to secure the future of beneficiaries' access to care. IPAB does just the opposite. It threatens seniors' access to health care, and that is why it must be repealed.

Madam Chairman, the Democrats got it right when they named the IPAB. It truly is the Independent Payment Advisory Board. It's independent from seniors, independent from people with disabilities, independent from the voters, independent from legal challenges and appeals, and independent from any accountability.

It's time to give that independence back to doctors, to patients, and to Congress by voting to repeal this Washington power grab. I urge my colleagues to join me in supporting repeal of the Independent Payment Advisory Board and to vote ``yes'' on this legislation.

March 7, 2012.

Dear Member of Congress: The organizations listed below

represent a breadth of entities including all sectors of the

healthcare industry, employers of different sizes and

geographic locations, as well as purchasers of care,

consumers and patients. We all share the conviction that the

Independent Payment Advisory Board (IPAB) will not only

severely limit Medicare beneficiaries' access to care but

also increase healthcare costs that are shifted onto the

private sector. While we all recognize the need for more

sustainable healthcare costs, we do not believe the IPAB is

the way to, or will, accomplish this goal.

As you know, the Patient Protection and Affordable Care Act

(PPACA [P.L. 111 148]) created the IPAB, a board appointed by

the President and empowered to make recommendations to cut

spending in Medicare if its spending growth reaches certain

measures. The IPAB will have unprecedented power with little

oversight, even though it has the power to literally change

laws previously enacted by Congress. Further, the law

specifically prohibits administrative or judicial review of

the Secretary's implementation of a recommendation contained

in an IPAB proposal.

We are deeply concerned about the impact the IPAB will have

on patient access to quality healthcare. The bulk of any

recommended spending reductions will almost certainly come in

the form of payment cuts to Medicare providers. This will

affect patient access to care and innovative therapies. In

the past five years for which data is available, the number

of physicians unable to accept new Medicare patients because

of low reimbursement rates has more than doubled. According

to an American Medical Association survey, current

reimbursement rates have already led 17 percent of all

doctors, including 31 percent of primary care physicians, to

restrict the number of Medicare patients in their practices.

In all likelihood, the IPAB will only exacerbate this

problem.

While we are all supportive of improving the quality of

care in this country, we are concerned that the IPAB will not

be able to focus on improving healthcare and delivery system

reforms, as some of its proponents have suggested. Requiring

the IPAB to achieve scoreable savings in a one-year time

period is not conducive to generating savings through long-

term delivery system reforms. According to a recent Kaiser

Family Foundation issue brief, ``[w]hile the requirement to

achieve Medicare savings for the implementation year provides

a clear direction and target for the Board, it may discourage

the type of longer-term policy change that could be most

important for Medicare and the underlying growth in health

care costs, including delivery system reforms that MedPAC and

others have recommended which are included in the ACA--and

which generally require several years to achieve savings. If

these delivery system reforms are not `scoreable' for the

first year of implementation, the IPAB may be more likely to

consider more predictable, short-term scoreable savings, such

as reductions in payment updates for certain providers.'' The

Congressional Budget Office (CBO) has in fact stated that the

Board is likely to focus its recommendations on changes to

payment rates or methodologies for services in the fee-for-

service sector by non-exempt providers. Again, this will have

a severe, negative impact on Medicare beneficiaries.

Last, we believe that the IPAB sets a dangerous precedent

for overriding the normal legislative process. Congress is a

representative body that has a duty to legislate on issues of

public policy. Abdicating this responsibility to an unelected

and unaccountable board removes our elected officials from

the decision-making process for a program that millions of

our nation's seniors and disabled individuals rely upon,

endangering the important dialogue that takes place between

elected officials and their constituents.

We do not believe the IPAB is the right way to achieve

savings in Medicare and strongly urge Congress to eliminate

this provision.

Sincerely,

Abigail Alliance, Action CF AdvaMed, Advocates for

Responsible Care, AIDS Delaware, AIDS Drug Assistance

Programs Advocacy Association, AIDS Housing Association of

Tacoma, AIDS Institute, Alabama Orthopaedic Society, Alabama

Podiatric Medical Association, Alaska State Chamber of

Commerce, Alaska State Grange, Alder Health Services, Inc.,

Alliance for Aging Research, Alliance of Specialty Medicine,

ALung Technologies, Inc., Alzheimer's & Dementia Resource

Center, Alzheimer's Arkansas, American Academy of Facial

Plastic & Reconstructive Surgery, American Academy of

Neurology.

American Academy of Otolaryngology--Head and Neck Surgery,

American Academy of Physical Medicine and Rehabilitation,

American Association for the Study of Liver Diseases,

American Association of Clinical Endocrinologists, American

Association of Clinical Urologists, American Association for

Homecare, American Association for Marriage and Family

Therapy, American Association of Neurological Surgeons,

American Association of Orthopaedic Executives, American

Association of Orthopaedic Surgeons, American Autoimmune

Related Diseases Association, American College of Emergency

Physicians, American College of Emergency Physicians--Indiana

Chapter, American College of Mohs Surgery, American College

of Osteopathic Surgeons, American College of

Radiology, American College of Surgeons--Missouri Chapter,

American Congress of Obstetricians and Gynecologists,

American Gastroenterological Association, American Liver

Foundation--Allegheny Division.

American Osteopathic Academy of Orthopedics, American

Physical Therapy Association, American Podiatric Medical

Association, American Society of Anesthesiologists, American

Society of Breast Surgeons, American Society of Cataract and

Refractive Surgery, American Society of General Surgeons,

American Society of Plastic Surgeons, American Society of

Radiation Oncology, American Urological Association,

Americans for Prosperity, Amigos por la Salud, Arizona

BioIndustry Association, Arizona Medical Association, Arizona

Podiatric Medical Association, Arizona Urological Society,

Arkansas Medical Society, Arkansas Orthopaedic Society,

Arkansas Podiatric Medical Association, Associated Industries

of Florida.

Association for Behavioral Healthcare, Association of

Nurses in AIDS Care, Asthma & Allergy Foundation of America--

California Chapter, Asthma & Allergy Foundation of America--

New England Chapter, Bay Bio, BEACON (Biomedical Engineering

Alliance & Consortium), Connecticut, BIOCOM, BioNJ, BioOhio,

Biotechnology Industry Organization (BIO), Bismarck-Mandan

Chamber of Commerce, California Healthcare Institute,

California Hispanic Chambers of Commerce, California Medical

Association, California Orthopaedic Association, California

Podiatric Medical Association, California Rheumatology

Alliance, California Urological Association, Capital Region

Action Against Breast Cancer!, Center of the American

Experiment.

Children's Rare Disease Network, Coalition for Affordable

Health Coverage, Coalition of State Rheumatology, Council of

University Chairs of Obstetrics & Gynecology Organizations,

Colorado Academy of Family Physicians, Colorado BioScience

Association, Colorado Cross-Disability Association, Colorado

Gerontological Society, Colorado Podiatric Medical

Association, Colorado Retail Council, Colorado Springs Health

Partners, Community Health Charities of Florida, Community

Health Charities of Nebraska, Congress of Neurological

Surgeons, Community Oncology Alliance, Connecticut

Orthopaedic Society, Connecticut Podiatric Medical

Association, Connecticut State Urology Society, Delaware

Academy of Medicine, Delaware Ecumenical Council on Children

and Families.

Delaware HIV Consortium, Delaware Podiatric Medical

Association, Delaware State Orthopaedic Society, Docs 4

Patient Care, Easter Seals, Easter Seals Crossroads, Easter

Seals Iowa, Easter Seals of Arkansas, Easter Seals of Maine,

Easter Seals of Massachusetts, Easter Seals of New Jersey,

Easter Seals of Southeastern PA, Easter Seals of South

Florida, Easter Seals UCP North Carolina, Elder Care Advocacy

of Florida, Florida Chamber of Commerce, Florida Medical

Association, Florida Podiatric Medical Association, Florida

Society of Neurology, Florida Society of Rheumatology.

Florida Society of Thoracic & Cardiovascular Surgeons,

Florida State Hispanic Chamber of Commerce, Florida

Transplant Survivor's Coalition, Florida Urological Society,

Georgia Association for Home Health Agencies, Georgia Bio,

Georgia Orthopaedic Society, Georgia Podiatric Medical

Association, Global Genes, Global Healthy Living Foundation,

Grand Rapids Area Chamber of Commerce, HEALS of the South,

Healthcare Institute of New Jersey, Healthcare Leadership

Council, HealthHIV, Hemophilia Foundation of Maryland, Heart

Rhythm Society,

Hoosier Owners and Providers for the Elderly, Idaho Medical

Association, Idaho Podiatric Medical Association.

Illinois Association of Orthopaedic Surgeons, Illinois

Biotechnology Industry, Organization--iBIO',

Illinois Chamber of Commerce, Indiana Association of Cities

and Towns, Indiana Health Care Association, Indiana Health

Industry Forum, Indiana Medical Device Manufacturers Council,

Inc., Indiana Neurological Society, Indiana Podiatric Medical

Association, Indiana State Medical Association,

InterAmerican College of Physicians & Surgeons,

International Franchise Association, International

Institute for Human Empowerment, International Society for

the Advancement of Spine Surgery, Iowa Orthopaedic

Society, Iowa Podiatric Medical Association, Kansas

Medical Society, Kansas Podiatric Medical Association,

Kansas Urological Association.

Kentucky BioAlliance, Kentucky Medical Association,

Kentucky Podiatric Medical Association, Kidney Cancer

Association of Illinois, Large Urology Group Practice

Association, Latino Diabetes Association, Licensed

Professional Counselors Association of Georgia, Louisiana

State Medical Society, Lupus Alliance of America--Hudson

Valley Affiliate, Lupus Alliance of America--Queens and Long

Island Affiliate, Lupus Alliance of America--Southern Tier

Affiliate, Lupus Alliance of America--Upstate New York

Affiliate, Lupus Foundation of Arkansas, Lupus Foundation of

America, DC/MD/VA Chapter, Lupus Foundation of Florida, Lupus

Foundation of Mid and Northern New York, Lupus Foundation of

the Genesee Valley, Lupus Foundation of Pennsylvania, Mabel

Wadsworth Women's Health Center, Maine Health Care

Association.

Maine Osteopathic Association, Maine Podiatric Medical

Association, Maine State Council of Vietnam Veterans of

America, Maryland Orthopaedic Association, Maryland State

Medical Society, Massachusetts Association for Behavioral

Health Systems, Massachusetts Association for Mental Health,

Massachusetts Biomedical Initiatives, Massachusetts Medical

Device Industry Council, Massachusetts Orthopaedic

Association, Massachusetts Podiatric Medical Society, Medical

Association of Georgia, Medical Association of the State of

Alabama, Medical Society of Delaware, Medical Society of the

District of Columbia, Medical Society of the State of New

York, Medical Society of New Jersey, Men's Health Network,

Mental Health America of Indiana, Mental Health America of

Greater Houston.

MichBio, Michigan Chamber of Commerce, Michigan College of

Emergency Physicians, Michigan Podiatric Medical Association,

Michigan Orthopaedic Society, Michigan Society of

Anesthesiologists, Minnesota Podiatric Medical Association,

Minnesota State Grange, Mississippi Arthritis and Rheumatism

Society, Mississippi Orthopaedic Society, Mississippi

Podiatric Medical Association, Missouri State Medical

Association, Missouri Urological Association, Montana

Orthopaedic Society, National Alliance on Mental Illness,

National Alliance on Mental Illness Colorado, National

Alliance on Mental Illness Florida, National Alliance on

Mental Illness Georgia, National Alliance on Mental Illness

Indiana, National Alliance on Mental Illness Maine.

National Alliance on Mental Illness Michigan, National

Alliance on Mental Illness NC, National Alliance on Mental

Illness Texas, National Association for Home Care & Hospice,

National Association for Home Care & Hospice--Indiana

Chapter, National Association for Home Care & Hospice--Ohio

Chapter, National Association for Uniformed Services,

National Association of Manufacturers, National Association

of Nutrition and Aging Services Programs, National

Association of People with AIDS, National Association of

Social Workers NC, National Association of Spine Specialists,

National Council of Negro Women, National Council of Negro

Women--Los Angeles View Park Section, National Council for

Community Behavioral Healthcare, National Health Foundation,

National Hemophilia Foundation--Delaware Valley Chapter,

National Kidney Foundation--Ohio Chapter, National Medical

Association, National Minority Quality Forum.

National Retail Federation, NCBIO, Nebraska Academy of

Physician Assistants, Nebraska Medical Association, Nebraska

Orthopaedic Society, Nebraska Urological Association,

Neurofibromatosis Mid-Atlantic, Nevada Orthopaedic Society,

Nevada Podiatric Medical Association, Nevada State Medical

Association, New Hampshire State Grange, New Horizons Home

Health Services, New Jersey Academy of Ophthalmology, New

Jersey Mayors Committee of Life Science, New Jersey Podiatric

Medical Society, New Mexico Podiatric Medical Association,

New York Podiatric Medical Association, New York State

Rheumatologists Society, New York State Urological

Society, North Carolina Association on Aging.

North Carolina Psychological Association, North Carolina

Rheumatology Association, North Carolina Urological

Association, North Dakota Chamber of Commerce, North Dakota

Medical Association, North Dakota Policy Council, Northwest

Urological Society, Ohio Association of Ambulatory Surgery

Centers, Ohio Association of County Behavioral Health

Authorities, Ohio Association of Medical Equipment Services,

Ohio Hospital Association, Ohio Orthopaedic Society, Ohio

State Grange, Ohio State Medical Association, Ohio Urological

Society, Ohio Veterans United, Oklahoma Podiatric Medical

Association, Oklahoma State Medical Association, Oklahoma

State Orthopaedic Society, Oklahoma State Urologic

Association.

Old North State Medical Society, Oregon Medical

Association, Oregon Podiatric Medical Association, Partners

in Care Foundation, Partnership for Drug Free North Carolina,

Pennsylvania BIO, Pennsylvania Chamber of Business &

Industry, Pennsylvania Medical Society, Pennsylvania

Orthopaedic Society, Personal Coaching & Psychotherapy for

Women, PhRMA, Premier healthcare alliance, RARE Project,

RetireSafe, Rhode Island Medical Society, Rio Grande

Foundation, New Mexico, Rocky Mountain Stroke Center, Rural

Health IT, Sanfilippo Foundation for Children, Society for

Cardiovascular Angiography and Interventions.

Society for Vascular Surgery, Society of Gynecologic

Oncology, Society of Urologic Oncology, South Carolina BIO,

South Carolina HIV/AIDS Care Crisis Task Force, South

Carolina Medical Association, South Carolina Orthopaedic

Association, South Carolina Podiatric Medical Association,

South Carolina Urological Association, South Dakota Podiatric

Medical Association, South Dakota State Orthopaedic Society,

South Jersey Geriatric Care PC, South Jersey Senior

Networking Group, Southeastern Medical Device Association

(SEMDA), Southwest Michigan Pharmacist Association, Stockton

Center on Successful Aging, Syndicus Scientific Services,

Team Sanfilippo Foundation, Tennessee Medical Association,

Tennessee Orthopaedic Society.

Tennessee Podiatric Medical Association, Texas Healthcare &

Bioscience Institute, Texas Podiatric Medical Association,

Texas Urological Society, The Center for Health Care

Services, The G.R.E.E.N. Foundation, The National Grange,

U.S. Chamber of Commerce, U.S. Pain Foundation, Urology

Society of New Jersey, Utah Medical Association, Utah

Podiatric Medical Association, Utah State Orthopaedic

Society, Vascular Society of New Jersey, Vermont Medical

Society, Vermont Podiatric Medical Association, Veterans

Health Council, VHA Inc., Vietnam Veterans of America,

Virginia Biotechnology Association.

Virginia Podiatric Medical Association, Visiting Nurse

Association of Ohio, Washington Biotechnology & Biomedical

Association, Washington Free Clinic Association, Washington

Osteopathic Medical Association, Washington State Podiatric

Medical Association, Washington Rheumatology Association,

Washington State Medical Association, Washington State

Urology Society, WERAK Foundation, West Virginia Academy of

Otolaryngology, West Virginia Chapter of the American College

of Cardiology, West Virginia Manufacturer's Association, West

Virginia Orthopaedic Society, West Virginia State Medical

Association, William ``Hicks'' Anderson Community Center,

Wisconsin Hospital Association, Wisconsin Urological Society,

Wyoming State Grange, Women Against Prostate Cancer.

Madam Chairman, I yield myself 15 seconds just to say that our Republican alternative, our Republican health care bill, prevented unlawful recisions, had no lifetime caps on coverage, did not deny coverage to those with preexisting conditions, and was the only bill that was scored by CBO as lowering premiums. Also, we did it without spending $2 trillion and 2,400 pages and did not create a board of 15 unelected bureaucrats.

With that, I yield 2 minutes to the distinguished chairman of the Health Subcommittee, the gentleman from California (Mr. Herger).

Madam Chairman, I yield 2 minutes to a distinguished member of the Ways and Means Committee, the gentlewoman from Kansas (Ms. Jenkins).

I yield myself 15 seconds.

I would just say that with regard to IPAB, the 15 unelected people appointed by the President, Congress can't simply reject the IPAB findings. Congress has to reject and find those savings somewhere else within the program, unlike the Base Closure Commission, which some Members have cited. And these are all people appointed by the President.

So with that, I would yield 2 minutes to a distinguished member of the Ways and Means Committee, the gentleman from Minnesota (Mr. Paulsen).

I yield 2 minutes to a distinguished member of the Ways and Means Committee, the gentleman from Illinois (Mr. Roskam).

I yield myself 30 seconds.

I would just say to my friend from New Jersey who says ``consider the source''--and the source is the American people--73 percent have expressed concern that the Medicare cuts recommended by IPAB would not only go into effect without congressional approval, but would also hurt their ability to get the Medicare services they need.

Let me just say I hear from my friends on the other side how important IPAB is to the integrity of Medicare. It is not effective until 2022. And let me just say with regard to the Medicare cuts that are in your health care bill, most of them don't take place until 2014. And I would just say that our health care bill included provisions that covered preexisting conditions, included many of the provisions the gentleman mentioned, and we did it without a tax increase, and we did it as the only health care bill that was scored by the Congressional Budget Office as decreasing premiums for American citizens.

With that, I yield 2 minutes to a distinguished member of the Ways and Means Committee, the gentlewoman from Tennessee (Mrs. Black).

Since the gentleman has asked, we are using those dollars to protect the Medicare program. You used those dollars to create a new entitlement which we can't afford.

Certainly you would reclaim your time.

I yield 2 minutes to a distinguished Member from Mississippi (Mr. Nunnelee).

Madam Chairman, I yield 2\1/2\ minutes to a distinguished member of the Ways and Means Committee, the gentleman from Washington State (Mr. Reichert).

I yield the gentleman an additional 30 seconds.

Madam Chairman, I yield 2 minutes to a distinguished member of the Ways and Means Committee, the gentleman from Texas (Mr. Brady).

Madam Chairman, I yield 2 minutes to the distinguished gentleman from Pennsylvania (Mr. Dent).

I yield the gentleman an additional 15 seconds.

Madam Chairman, I yield 2 minutes to a distinguished member of the Ways and Means Committee, the gentleman from Louisiana, Dr. Boustany.

I yield 2 minutes to the distinguished gentleman from Indiana (Mr. Pence).

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

Madam Chairman, I yield myself the balance of my time.

Nearly 70 percent of seniors are worried that IPAB will limit their Medicare choices and the coverage that's available to them under Medicare. I think this is the most troubling part of the health care law that the Democrats rammed through the Congress, and that is because this secret rationing board is given enormous power with no accountability.

The 15 unelected board members of IPAB are free to cut reimbursement rates for certain procedures or for services that they deem unnecessary. They can cut those rates so low that physicians will no longer be able to offer those services. That's pretty clearly the ability to ration.

We have had countless physician groups warn us about the IPAB. They're warning us that these cuts will force them to stop seeing Medicare patients, and the real problem is, because TRICARE reimbursement rates are tied directly to Medicare, that will have health care for our military personnel negatively impacted by the IPAB as well.

The Democrats gave IPAB blanket authority to operate in secret. There is no requirement that their deliberations, their reasonings for their conclusions must be made public. Also, the health care bill states directly that IPAB, and I'm quoting here, ``may accept, use, and dispose of gifts or donations of services or property.'' That's not a very subtle invitation for lobbyists and others with interests in issues before the Congress to impact these unelected and unaccountable IPAB members with cash, with gifts, with other items.

So not only do they have enormous power that if the Congress can't override automatically becomes law. But they have the ability to do it in secret, and the legislation states directly that they can accept gifts and donations.

So this is a troubling piece of ObamaCare that we need to repeal, and I urge my members to vote for repeal of this.

I yield back the balance of my time.

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

I rise in opposition to H.R. 5. It combines two very bad ideas into one terrible bill that is anti-senior, anti-consumer, and anti-health.

It's no accident that we're considering the legislation during the second anniversary of the Affordable Care Act, because this is a thinly veiled, partisan attempt to confuse the public and obscure the law's success in covering young people, reducing costs for seniors, and providing improved health benefits.

Title I of the bill before us, the medical malpractice provisions, have been around for over a decade. They have not been enacted under Democratic or Republican Congresses and Presidents because they are an extreme intrusion on the authority of the States to set their own liability rules and would shield bad actors from accountability when they cause injury and death.

Let's be clear: this bill is much broader than traditional medical malpractice legislation. It protects manufacturers, distributors, suppliers, marketers, even promoters of health care products. And it gives them protection even if they intentionally cause harm. Insurance companies and HMOs are protected as well. The bill shields drug and device manufacturers with complete immunity from punitive damages, no matter how reckless their conduct, so long as their products were at one time approved by the FDA.

This bill preempts State action in an area that has traditionally been left to the States. To the extent that we do have a medical malpractice problem in this country, it should be addressed at the State level. But this bill not only strips away State law; it puts in place a Federal scheme that will not reduce medical errors, will not award appropriate and adequate compensation when an injury occurs, and will not lower health care costs.

The second part of the bill would repeal the Independent Payment Advisory Board, which helps keep Medicare costs under control if they rise more than anticipated. IPAB's role is to recommend evidence-based policies to improve Medicare without harming patients.

Repealing IPAB is the height of hypocrisy. The main Republican attack on Medicare and the Affordable Care Act is that we cannot afford them. House Republicans are proposing changes that would destroy Medicare because they say taking care of our seniors just costs too much. Yet today they will vote for a bill that eliminates one of Medicare's cost- saving innovations and saddles Medicare with over $3 billion in unnecessary costs. It's no wonder that the public holds Congress in so little regard.

The Republican master plan for Medicare is to end the guarantee coverage and shift more costs on to seniors and people with disabilities. They don't hold down the costs; they simply shift them on to seniors and disabled people. Under Medicare, they pay more for it out of their own pockets. This is part of the Republican assault on Medicare. It would repeal the backstop in Medicare that keeps Medicare affordable for seniors.

I want to be clear about what the IPAB is and what it isn't. The board is explicitly in statute prohibited from rationing. It also is prohibited from making recommendations that increase costs to seniors or cut benefits. IPAB also doesn't take away the role of Congress. IPAB makes recommendations, but Congress can and should act on those recommendations.

We hear a lot about these unelected bureaucrats. Let me tell you that, around this place, there are a lot of elected bureaucrats. Here is the fundamental difference between the Democratic approach to Medicare and the Republican approach: Democrats in Congress are committed to preserving Medicare and protecting seniors' benefits; Republicans have proposed ending Medicare's guarantee of coverage so they can pay for tax breaks for oil companies and millionaires. Let me underscore that. They want to take money out of Medicare so they can give more tax breaks to billionaires and oil companies.

Like some of my colleagues, I have concerns about some aspects of the IPAB. I don't agree with the premise that we need IPAB to make Congress do its job. But no one should think that the hyperbole of IPAB's Republican critics--rationing, death panels, and faceless bureaucrats pulling the plug on sick patients--represents reality. That came from their propaganda word masters.

House Republicans are voting to repeal the Independent Payment Advisory Board because they simply want to eliminate Medicare. They want to provide vouchers instead of benefits. They want to shift costs to the beneficiaries. They want to put Medicare into a death spiral and leave insurance companies in charge of seniors' care. Then it would be the insurance companies that could then ration care, cut benefits and, according to the Congressional Budget Office, likely increase out-of- pocket costs by $6,000.

Does anybody doubt insurance companies ration care? Try to get an insurance policy if you have a previous medical condition. They won't even cover you, or they will charge you so much you can't afford it. Is that what we want, to let the insurance companies make these decisions for our seniors and disabled people?

H.R. 5 is a partisan assault on Medicare and an assault on patients who are injured by careless doctors and drug companies and an assault on States' rights.

I urge my colleagues to vote ``no'' on H.R. 5.

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

Mr. Chairman, I am pleased at this time to yield 3 minutes to the distinguished ranking member and soon-to-be chairman of the Health Subcommittee, the gentleman from New Jersey (Mr. Pallone).

Mr. Chairman, I am pleased to yield to an important member of our committee, the gentleman from Texas (Mr. Green) for 2 minutes.

Mr. Chairman, I'm always amused when I hear people talk about government interference in our lives. If people think Medicare is an unjust government interference in their lives, they can forgo their Medicare, but I don't know too many people who would like to do that. What the Republicans are proposing is to take that Medicare away from them and turn it over to private insurance. Put that to a vote. I don't think the American people would support that either.

I am pleased to yield 2 minutes to a very important member on our committee, especially the Health Committee, the Representative from the Virgin Islands (Mrs. Christensen).

Mr. Chairman, I am pleased to yield 3 minutes to my colleague from California, one of the key people in the authorship of the Affordable Care Act, George Miller.

Mr. Chairman, I yield myself 1 minute.

We're talking about the Independent Payment Advisory Board--advisory board.

The appointed membership of the Board shall include

physicians and other health professionals, experts in the

area of pharmaco-economics or prescription drug benefit

programs, employers, third-party payers, individuals skilled

in the conduct and interpretation of biomedical, health

services.

Dot, dot, dot. These are people who will give us some recommendations, but they can't give us recommendations to take away services. They can't give us a recommendation to impose more costs on the Medicare beneficiaries. And when they give us their recommendations, Congress can act on it. And if we don't like it, we can change them.

I think we have the Republicans trying to scare people. They come in and say ``Medicare costs too much.'' Well, if it costs too much, that's why we need this backup, to be sure that we're holding down costs. They say, ``it costs too much and therefore let's ends it.'' That doesn't make any sense. I think Americans should not be fooled.

Mr. Chairman, I would like to now yield 3 minutes to my colleague from California, the ranking member of the Subcommittee on Health of the Ways and Means Committee, Mr. Stark.

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

Mr. Chairman, I yield myself 1 minute.

We hear these things now, but we heard them in 1965 when Medicare was being proposed--socialized medicine, an unfair government intrusion into our lives.

Medicare is a popular, successful program. I support it. But the Republicans didn't support it then, and they don't support it now.

The Affordable Care Act is an excellent bill. I proudly voted for it because as a result of that legislation we're already seeing young people being able to get insurance up to 26 years of age on their parents' policies. We're already seeing seniors getting help to pay for their prescription drugs. We are seeing insurance companies prohibited from the abuses where they put lifetime limits, and they're going to be stopped from denying people health insurance because of preexisting medical conditions. This is good, and we're going to get even more benefits for over 30 million Americans when the bill is fully in place.

It's a good bill. The Republicans would like to repeal it. But let's not forget, they didn't want Medicare in the first place.

Mr. Chairman, now that I've used my minute, I would like to yield 3 minutes to a member of our committee from the State of Illinois (Ms. Schakowsky), who has been very involved in helping seniors on all of these programs, whether it's Social Security or Medicare or Medicaid. She is very knowledgeable and highly respected--a little shorter than the podium, but I'm pleased to yield to her.

(Ms. SCHAKOWSKY asked and was given permission to revise and extend her remarks.)

Mr. Chairman, may I inquire how much time each side has.

Mr. Chairman, at this time I'd yield 5 of our 36 minutes to the gentleman from Iowa (Mr. Braley).

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

Mr. Chairman, I yield myself 1 minute.

I thank the gentleman, who is a physician, for his comments.

He said he wants to save Medicare. He said the Republicans want to save Medicare. They want to save Medicare, but their budget proposal would end Medicare.

Let's just understand, those who are on Medicare know they can go to the doctor or the hospital or other health care provider and Medicare will pay. Under the Republican proposal, they'd be given a voucher and told to go buy a private insurance policy, as much as they could afford by adding additional money. To save it, they want to end it.

And we hear the statement, so-called pain and suffering. For people who are living their lives with constant pain and suffering from a medical malpractice problem, it's not so-called to them. It's a real, terrible situation that they have to live with.

I think that, because one of our speakers happens to be a trial lawyer, I want to point out that the past speaker is a medical physician, as if that should make a difference. Let's base our arguments on the points that are made.

I, at this point, want to yield 3 minutes to the gentleman from Vermont (Mr. Welch), an important Member whom we hope will come back to our committee in the very near future.

Mr. Chairman, I am pleased at this time to yield 4 minutes to the distinguished Democratic whip, Mr. Hoyer, from the State of Maryland.

I yield the gentleman an additional minute.

Mr. Chairman, nobody is going to deny that there is a problem with medical malpractice. The issue is whether the State of Tennessee can adopt a law to solve its own problem the way the State of California has done, the way the other States have acted. Let the States operate in this area which has been traditionally reserved for them. Washington does not have all the answers. Imposing one system on the whole country is not the way to go.

I would like to at this point yield 3 minutes to the gentleman from the State of Washington (Mr. McDermott).

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

I yield the gentleman 1 additional minute.

Will the gentleman yield?

We want to hold down the costs in health care for Medicare, itself. The cost of health care is going up for all health care coverage; but Medicare, if it goes up too much, it's a real problem. So in the Affordable Care Act, we try to put in place ways to hold down costs by reorganizing the delivery of care. We have some other strategies. We hope it will work. But for a backstop, if it doesn't work, there is this Independent Payment Advisory Board, and they will give us some idea as to how to hold down health care costs.

Now, it seems to me, the biggest objection is, once they give their recommendations, we can accept them, we can change them, or we can let them go into effect. I think the biggest problem is that if nothing happens, those health care costs go up; and that's what preserves the right of Congress, is to let nothing happen. And this is not how to hold down costs. This is to let the costs go up.

I thank the gentleman for yielding.

Mr. Chairman, may I inquire how much time each side has remaining in the general debate.

I will reserve the balance of my time.

I continue to reserve the balance of my time.

I yield myself such time as I may consume.

Mr. Chairman, our idea for Medicare for the future is to make it better, not to eliminate it. In the Affordable Care Act, we provide help for seniors to pay for their prescription drugs, especially when they're in the doughnut hole. We provide money so they will be sure to have preventive services without having to pay for them so that we know we can prevent diseases that we otherwise have to pay to treat. We have extended the life of the Medicare trust fund. We're always looking for ways to hold down costs in a reasonable, rational way.

One of the reasons we have very high costs in Medicare is, when a doctor and a patient get together, the doctor decides on how many services are going to be paid for, especially when that doctor gets paid more money for more services. Therefore, we've got to look for alternatives to that. Now I have a feeling the doctors like the idea of deciding how many services are going to be paid for, but we just can't afford that.

So we have ways to hold down health care costs by trying to bring people together in affordable care organizations, ways for doctors to manage the care from physician to physician in a more efficient way, and we have a backup if these other things don't work--to have an advisory committee to give us their ideas; but their ideas cannot lead to rationing health care or making people have to pay more money for their insurance or to restrict benefits or modify eligibility. That's what we propose to do.

The Republicans propose to take away the assured guarantee of services under Medicare and require people to go find a private insurance plan, if they can afford it, over and above the voucher, which would never keep pace with the increase of health care costs.

At this time, I yield 2 minutes to my California colleague (Mr. Thompson).

I yield myself such time as I may consume.

Mr. Chairman, if you listen to the comments that were just made on the House floor, it would be better to leave over 30 million people without health insurance because they want to see doctors when they get sick.

The legislation, the Affordable Care Act, provides more training for doctors and higher reimbursement for primary care doctors, and it provides for the opportunity to get a medical education with a payback in underserved areas. We're going to get more doctors, but we shouldn't say that those who have health insurance should turn their backs as the Republicans, I feel, are doing to all of those who have no insurance whatsoever.

I want to yield, at this point, 5 minutes to the distinguished gentleman from the State of Virginia (Mr. Scott) so he can further speak on this legislation.

We have one.

Mr. Chairman, I am pleased at this time to yield 2 minutes to the gentleman from New Jersey (Mr. Holt).

I'd like to yield 1 additional minute to the gentleman and ask him to yield to me.

The problem that we keep facing is rapidly rising health care costs. It's not just for Medicare; it's for private insurance. It's for anybody who has health coverage that costs of health care are going up rapidly. The approach of Medicare has always been to look for ways to hold down the cost.

There was a time when ophthalmologists would charge a fee for removing the cataract and then ask for another fee for inserting the lens. Well, that made sense when that surgery was brand new, but they didn't want to give up the two fees that they were receiving because it would be a reduction in their reimbursement. But Medicare said no, that really doesn't make sense. Medicare does a lot of things to hold down cost, and then private insurance picks them up because so often they make sense.

I yield the gentleman another 30 seconds.

The way to hold down cost is to try to reform the way health care is delivered. Medicare tries to do that. If we don't do it that way, the Republicans would say that private insurance will be able to control it because that's all people are going to be able to get. No more Medicare. They will have to buy private insurance and let the insurance company tell the doctor and the patient what they will be able to do with their trying to hold down cost, without regard to the Medicare patient.

I thank the gentleman for yielding to me.

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

Mr. Chairman, I thank the gentleman for yielding. And, of course, I stand in strong support of H.R. 5, the PATH Act, having authored half of the legislation, that is, the HEALTH Act, the medical liability reform act.

But I'm also strongly in favor of repeal of IPAB, the Independent Payment Advisory Board created under ObamaCare. We know and our colleagues on the other side of the aisle, many of them, know that this is the most egregious part of this 2,700-page piece of legislation, which is now the law of the land. But what it is, Mr. Chairman, IPAB, is their way of saving Medicare.

I'll ask them time after time: What is your plan to save Medicare? They have no answers. All they want to do is continue to criticize our side of the aisle when we have meaningful, thoughtful plans to save and protect and strengthen, not just for these current recipients under the Medicare program, those who are seniors, those who are disabled, but also our children and our grandchildren.

What do we get from this side of the aisle, from the Democratic side? We get IPAB.

The language says no rationing, yet the provisions call for cutting reimbursements to providers; and eventually, without question, just as it has in Canada and the UK, Mr. Chairman, that leads to the denial of care. If that's not rationing, I don't know what it is.

Let me, in the remaining part of my time, speak a little bit in regard to H.R. 5, the HEALTH Act, the medical liability reform act.

The gentleman from Iowa, the trial attorney, was just up here trying to imply that we would take away a person's right to a redress of their grievances if they had been injured by a medical provider or a health care facility because of practice below the standard of care.

And I thank the gentleman.

The gentleman from Iowa knows, in fact, that that is absolutely not true.

What we do in this HEALTH Act is limit the awards for so-called pain and suffering at $250,000. And, Mr. Chairman, indeed, a number of States, after California enacted this law 35 years ago--Texas, Florida, my own State of Georgia--have enacted caps higher than that, and, no doubt, other States will do so in the future, because this bill specifically says--and it's called the flex caps--that if a State wants to enact a limit on noneconomics of $1 million and have it applicable to multiple defendants, they can do that. They have the right to do that. And in regard to the injury to a patient, there are no caps whatsoever. There are still suits that are awarded to injured patients that are in the millions of dollars.

So the gentleman from Iowa was totally disingenuous in what he was trying to explain--a very smooth talking, very convincing lawyer. That's what we expect.

But we want to end frivolous lawsuits so that those who are truly injured get their day in court, and that's what this bill does.

Madam Chairman, as a physician Member and coauthor of the bill, I am truly honored that Chairman Pitts is allowing me to close the debate on H.R. 5, the PATH Act--appropriately named. For meaningful medical liability reform and the elimination of IPAB together will put Medicare in specific, and health care in general, back on the right path: a path to fiscal solvency for one- sixth of our economy; a path to compassionate, cost effective, efficient, and timely health care for all who call this great country home; a path to fairness in our court systems so that those injured by malpractice get their day before a jury of their peers and they are justly compensated, not crowded out by the growing problem of frivolous claims and out-of-control legal fees; a path to a bipartisan and a bicameral solution to one of the most pressing issues that this Nation will ever again face, that is, to save Medicare for our current seniors and strengthen it for all future generations.

Let's get started right now. Our country cannot wait any longer. Vote ``yes'' on H.R. 5, the right PATH Act.

Mr. Chairman, I thank the chairman of the Judiciary Committee for yielding to me and the opportunity to follow directly my colleague from Georgia on the other side of the aisle.

A number of things were said. I feel grateful to have the opportunity to address those.

One of the comments that the gentleman made, the gentleman is my good friend, and he would agree with that. But in regard to this emergency caucus meeting with the Tea Party Caucus on the Republican side with our majority leader, Eric Cantor, I am an original member of the Tea Party Caucus in the House of Representatives. If there had been any emergency-called meeting, Mr. Chairman, I can assure you that I would have been right there with Michele Bachmann and Steve King and others, the 20 of us that were original members of the House GOP Tea Party Caucus. There was no such meeting.

Let me refute that statement, although I greatly respect my friend from Georgia, from DeKalb.

I will be glad to yield to my friend.

Reclaiming my time, and he did say that. He said it was his understanding. He didn't say it was a matter of fact. I appreciate that comment.

But another thing, Mr. Chairman, that I want to address, he named names. I think the lady's name was Ms. Palmer of Marietta, Georgia. I live in Marietta, Georgia, and have for the last 36 years. I represent Marietta, Georgia, in the 11th Congressional District and have for the last 9\1/2\ years.

The description of this unfortunate soul's injuries and the things that happened to her, the broken bones, the collapsed lung, the lack of blood flow to the extremities because of an improper placement of an intravenous line, maybe instead of in a vein in an artery, that resulted in amputations of her upper extremities. When the general public hears stuff like that, Mr. Chairman, they're horrified.

To think that we on this side of the aisle with H.R. 5, the HEALTH Act, which is part of the PATH Act that we are discussing on the floor today, to suggest that a person that suffers like that could only recover $250,000 in non-compensatory pain and suffering is absolutely untrue.

The gentleman, my friend from DeKalb, is an attorney. He knows the legal system. He's been in the courtroom. I'm not sure whether he's tried on the side of the plaintiff or the defense in regard to medical malpractice cases, but he clearly knows the difference in noneconomic pain and suffering in regard to this particular bill, and, on the other hand, recovery for severe losses, medical compensation, loss of wages, loss of extremities, what this poor soul suffered.

Let me just read, Mr. Chairman, this comment: Nothing in the HEALTH Act denies injured plaintiffs the ability to obtain adequate redress, including compensation for 100 percent of their economic loss. Essentially, anything to which a receipt can be attached. Believe me, the plaintiff's attorney will attach every receipt, including the medical costs, the cost of pain relief medication, their loss of wages, their future lost wages, rehabilitation costs, and any other economic out-of-pocket loss suffered as a result of a health care injury.

Economic damages include anything whose value can be quantified, including lost wages, home services, au pair, companion to go shopping, medical costs, rehabilitation of a home, access for someone who has an incapacity, an inability to access a normal home.

So, the gentleman, just like the gentleman from Iowa, the plaintiff's attorney that spoke on the floor earlier in regard to misleading statements, to suggest that in this legislation we would take away the ability of a person like Ms. Palmer of Marietta, Georgia, for a full and complete redress of grievances if a medical practitioner or a facility has performed below the standard of care for that local community--my colleague, the chairman of the Judiciary Committee, the distinguished chairman, gave me some statistics in regard to some of the economic losses that people have incurred and judgments that have been awarded by a jury of their peers.

Listen to this, Mr. Chairman. In August of 2010, Contra Costa County, a judgment for $5,500,000. These are California cases, by the way, Mr. Chairman. It's California law that H.R. 5 is based on. MICRA passed back in 1975.

But these are cases in 2010. This one in February 2010, Riverside County, $16,500,000; November, 2009, Los Angeles County, $5 million; October, 2009, Sacramento County, $5,750,000. I will go down to the last one, although there are several others on the list. July, 2007, Los Angeles County, an award of $96,400,000. This, Mr. Chairman, is in 2007. MICRA was passed in 1975.

This case in 2007, this plaintiff may have been awarded $250,000 noneconomic because there was a cap. But the cap is there not to deny them their day in court, their ability to be judged by a jury of their peers and a decision made in regard to just compensation.

There are 21 members of the House GOP Doctors Caucus. It includes 16 physicians, a psychologist, several dentists, several registered nurses. I'll guarantee you, Mr. Chairman, in every one of these cases I mentioned coming out of California, we would be sitting there fighting for those plaintiffs. Maybe even a witness for the plaintiff, for Mrs. Palmer, to say the sky is the limit, and, Mr. Plaintiff's Attorney, you tack on every economic cost that you can dream up, and we'll vote in favor of it.

But what we are opposed to, Mr. Chairman, is this opportunity for people to come in to court and clog up the court system and crowd out Mrs. Palmer and maybe many of these cases from California with frivolous lawsuits where there is no justification for the claim, where people are just hoping with a lottery mentality that some sympathetic jury will just simply say, Oh, gosh, we know there's no damage here. But after all, the doctor has $10 million worth of insurance. It's not coming out of his pocket. Let's award the plaintiff $6 million or $8 million worth of noneconomic pain and suffering--if you want to call it that--in damages.

That's the thing that's got to stop. That's what's causing the price of health care to rise astronomically. That's why doctors are ordering all of these unnecessary tests and practicing defensive medicine. Every time a patient comes to the emergency room with a headache, even though the doctor is skilled in physical diagnosis, in taking a history, and can examine that patient and look in their eyes, making sure there is no bulge of the pupils or the optic discs, they know that patient has a tension headache. They know it's perfectly safe to send him or her home with a prescription to return in 24 hours. But, no, because of these frivolous lawsuits, they're going to order a CAT scan that costs $1,500. You multiple that time and time and time again, that's what this is all about. That's the problem we're trying to solve.

For my friend from DeKalb--and he is my great friend--or my friend from Iowa or, indeed, the former Speaker, the minority leader, Ms. Pelosi, to come to the floor and very eloquently--and she is eloquent and speaks with a lot of passion, great ability, a great communicator-- but to mislead is downright wrong.

The truth needs no adjectives, Mr. Chairman. The truth is what is in the PATH Act, H.R. 5. And I say to my colleagues: We need to pass this and do this in a bipartisan way and not worry here about what's going to happen in the Senate. Let's do the right thing in the House of Representatives, and let's do the people's work.

I thank the gentleman for yielding. This is his time, and I appreciate him yielding. It gives me an opportunity to explain in regard to joint and several liability.

Mr. Chairman, it's important for our colleagues on the House floor and anyone within shouting distance to understand what we're talking about in regard to joint and several liability.

Under current law, anyone who is named as a defendant in a medical malpractice suit is liable for whatever judgment is rendered. It matters not how much they participate in the case.

Let me give my good friend from Michigan, the ranking member of the Judiciary Committee, an example. Of course he knows this. Let's say it's an OB/GYN case and the surgeon who has done a hysterectomy on Friday is going to church on Sunday morning and asks his colleague to stop by and see the patient and to tell her that he'll be around that afternoon to check on her. The doctor says, sure, I'll be glad to.

He peeks his head in the door and Mrs. Jones said, I'm fine.

Okay. Your doctor will be around this afternoon to check on you.

Things go to heck in a hand basket. The operating physician maybe has practiced below the standard of care. But that doctor that covered, that peeked in the door, that really had nothing to do with the case, surely, as Mr. Conyers knows, will be named in the lawsuit. And if he or she happens to have the deepest pockets under the current law, they could be liable for the entire judgment; whereas the doctor who practiced below the standard of care, who has a shallow pocket, would get off scot-free.

I yield back to my friend, and I thank you for the opportunity.

The answer is ``yes.''

Mr. Chairman, I appreciate Chairman Smith yielding to me. And, of course, with great hesitation do I rise, because the gentlewoman who just spoke was recently rated one of the most eloquent, if not the most eloquent, Members of this body.

But even though she is eloquent, with all due respect, I think she is wrong. And with regard to the issue of the Commerce Clause and the issue of the Affordable Care Act, PPACA, and as is sometimes referred to, and not really pejoratively--if successful, it will be his legacy-- ObamaCare.

This bill, Mr. Chairman, was created by forcing individuals to engage in commerce; that is, to purchase health insurance, under the penalty or a tax--I'm not sure from day to day how they're going to describe it, but without question that's not constitutional. And I expect maybe it will be a 5 4 decision in June of the Supreme Court, but maybe 9 0, because that is clearly unconstitutional. It is not applicable under the Commerce Clause to force people to engage in commerce. The Constitution says to regulate interstate commerce.

Of course, that is very much applicable in H.R. 5, in the Medical Liability Reform Act. Because when you have a situation in health care where there is no provision for certain medical specialties in a high- risk area like neurosurgery, obstetrics and gynecology, cardiovascular surgery, where babies have to be delivered beside the road.

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

I hope everybody's been listening to this. What has become clear is this: the Republicans have a 3-act play. First, repeal IPAB; next, repeal the rest of health care reform; and, finally, repeal Medicare.

It is so hypocritical to come forth and say that the efforts of Republicans is to protect Medicare when the purpose of it is to destroy it. That's what would happen if they had prevailed before. That's what would happen if they prevail today with their voucher plan.

So the third act really came forth before the first act. They rolled out, yesterday, their budget plan that essentially would repeal Medicare, would destroy it. There would be a voucher and, over time, the end of Medicare.

It's an essential commitment to the seniors of this country, and we Democrats are determined to thwart every effort to destroy it.

Now, as to the first act, repeal IPAB. You know, it's interesting that Medicare is a major instrumentality for ensuring that over time the costs of Medicare are brought under control, protecting the health care opportunities of seniors. Indeed, there have been efforts already under the Affordable Care Act to bring under control the costs of Medicare, to make sure it survives.

So being an essential part of controlling health care costs over the long term, the Republican proposal, essentially, would go in the opposite direction. And that's why the CBO, last year projected--and I want everybody to listen to this--that health care costs would jump by 39 percent under the Republican plan to end the Medicare guarantee. That's why 300 economists have said that health reform puts into place, essentially, every cost-containment provision policy that analysts have considered. It's because of those policies that CBO has given this estimate that IPAB isn't going to be triggered until some time after 2022.

So what happens is, the Republicans come forth with the repeal of IPAB as a first step towards repealing Medicare when they have never presented an alternative in terms of the Affordable Care Act. So, today, we hear all the scare tactics about a board whose operation effectively won't be triggered for a decade. That's a scare tactic that is not worthy of this floor, so I urge very much that we oppose.

It's interesting that the Republican budget has a cap that is more severe, if you want to put it that way, more strenuous than the provision that relates to IPAB. And so they come forth, and they say that IPAB, which won't be triggered until 2022, is something that they should oppose, while they want to put in place a budget this year that would have a more severe cap than is in IPAB. Let me also say the notion that there is some agency here that could act without any role for Congress is simply untrue. It's not true. You shouldn't say it.

We have an opportunity, once IPAB goes into operation, to review any recommendation that comes forth, and to replace it, as long as the various targets are met. So I urge very much that we reject this proposal in part because the repeal, in and of itself, I think, is a mistake but mainly because of what the aim is here, and that has been so clear from the debate, because people who come here on the Republican side, some of them talk about IPAB; some don't even discuss IPAB. They talk about the Affordable Care Act.

The polling data we have is essentially relating to the Affordable Care Act as well as to IPAB. I think the more people understand what has been going on, the more they see the benefits of health care reform, the more they will be supportive of it. We're going to take that case to the American people.

Let me just give you a few numbers that everyone should know about

I now yield 3 minutes to the distinguished member of our committee, Mr. Blumenauer, from the proud State of Oregon.

I yield the gentleman an additional 2 minutes.

I yield 4 minutes to a member of our Ways and Means Committee, the gentleman from Wisconsin (Mr. Kind).

I yield to the gentleman 2 additional minutes.

I now yield 4 minutes to the gentleman from Texas, a member of our committee, Mr. Doggett.

It's curious. You're talking about, according to CBO, a board whose operation would be triggered in 2022. You come here and scare people. It doesn't work. You talk about rationing. You're talking about an operation 10 years from now.

Right now, health care is being rationed. You have 50-plus million people who have no insurance, 50-plus million people who have no insurance at all, and you haven't come up with a bill that would address that.

I am proud to yield 4 minutes to the gentleman from New Jersey (Mr. Andrews), who has been so key in the health care debates.

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

I yield the gentleman 2 additional minutes.

Let me just say it is strange to say you save something by destroying it. That is 1984 in 2012.

I now yield 2 minutes to the gentleman from New Jersey.

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

It is now my privilege to yield 3 minutes to the distinguished gentleman from Missouri (Mr. Clay).

I yield myself such time as I may consume.

We're talking about a board whose operations trigger, according to CBO, 10 years from now.

I just want to say to those who say it's unaccountable: Every one of their recommendations will come before the Congress of the United States, every single one. What's unaccountable are the statements that are made on this floor that are not true.

I reserve the balance of my time.

No. What the Republicans would do would be to send the decisions already there in large measure to insurance companies.

I reserve the balance of my time.

I yield myself 1 minute.

The present system doesn't have enough primary care. I know from my own experience that there's a lack of family physicians and primary care physicians. The Affordable Care Act strengthens that program, will strengthen the relationship between the physician and the patient. And for anybody to come here and scare patients and seniors into thinking that there is some kind of a wall that will be replaced is really not true.

I yield to the gentleman.

I yield myself an additional 1 minute.

Look, I respect that. But the primary fact, the basic fact is that the Affordable Care Act addresses this issue more effectively than has been addressed before. There is more money for primary care physicians, for family physicians. That's what we need. That's what we need.

And to come here and raise the specter that this bill is going to diminish it, when its major purpose, among others, is to increase the availability, to have a linkage between the patient and the specialty care--

I yield myself an additional 30 seconds.

Look, we need to address it, but destroying Medicare is not the way to address it. That's what you do. You destroy it. You destroy it when you say you're saving it.

I reserve the balance of my time.

I yield myself the balance of my time.

Look, the Supreme Court will be hearing the case about the individual mandate next week, and I don't think we want to argue this now. We don't have any judges here.

But let me say, on the individual mandate, it really is ironical that the more conservative, apparently, you are, the more you dislike the individual mandate, when the individual mandate was the central point within the health care reform proposal of conservatives in this country several decades ago. It was their central point in the eighties and in the nineties. And now they've reversed course and claim, I guess, what they proposed in the seventies and eighties was constitutional then is unconstitutional today. Talk about a flip-flop. That is, I think, maybe an unconstitutional flip-flop, but the Court will decide that.

Let me just say a word about cost containment and the importance of our addressing that and the importance of our reforming the present system, how we reimburse the fee-for-service system. I don't think it's been noticed that, in addition to IPAB, ACA has a number of provisions that will go into effect long before IPAB could become operational. Those systems are beginning to work.

For conservatives who talk about the importance of cost containment, they want to repeal an act that has within it not only the seeds of cost containment, but the instrumentalities of it. In fact, they're beginning to work well enough. That's why CBO says that it's going to be 10 years before IPAB is triggered.

So, those who come here who claim to be concerned about cost containment essentially are undermining their own position.

Well, this is act one of the Republican three-act play.

The second is to eliminate health care reform altogether, and the third is to take away Medicare.

I want to close reporting the views of AARP in terms of the Ryan budget proposal. It says:

It lacks balance, jeopardizes the health and economic

security of older Americans. A number of proposals in this

budget put at risk millions of individuals by prioritizing

budget caps and cuts over the impact on people.

Those who talk about the cap that would essentially be within the structure of IPAB's operation, that proposed cut is less than in the Ryan budget, which would be more severe, and essentially the implementation would be by insurance companies who are nameless, who are unaccountable.

So let me continue with another quote from the AARP:

By creating the premium support system for Medicare

beneficiaries, the proposal is likely to simply increase

costs for beneficiaries while removing Medicare's promise of

secure health coverage--a guarantee the future seniors have

contributed to through a lifetime of hard work.

The premium support method described in the proposal,

unlike private plan options that currently exist in Medicare,

would likely `price out' traditional Medicare as a viable

option, thus rendering the choice of traditional Medicare as

a false promise.

So this is what I think we should do in terms of this three-act play of the House Republicans. That is to start by rejecting act one, this repeal of IPAB.

This may be a vote, but it's not going to be an act.

I finish with this. In a sense, you are acting because this isn't going to become law. You have not come up in all of these months with a comprehensive alternative to the Affordable Care Act. There's not been a comprehensive bill put forth. We haven't voted on a comprehensive bill in these days on the Ways and Means Committee. Instead, there has a piece-by-piece effort to dismantle what was health care reform to address a serious situation, including over 50 million people who go to sleep every night without health care coverage in the United States of America.

We should be ashamed of that. We should be ashamed. A couple years ago, we acted to lift that shame off of the shoulders of all of us in the United States of America.

I urge we vote ``no'' on this bill.

I yield back the balance of my time.

Let me thank the ranking member and also the chairman of the Judiciary Committee and the leadership for giving us the opportunity to celebrate, as we debate H.R. 5, the Affordable Care Act, which is 2 years in the making.

Clearly, it speaks to where we are today. So in celebration of the Affordable Care Act, let me first of all wish it a happy anniversary.

Before I start on the Affordable Care Act, let me indicate to my good friend from Georgia and the Physicians Caucus that many of us do not take a back seat to our support for physicians. How can I help myself, coming from a community where the Texas Medical Center is fighting for a permanent doctor fix, which we've not been able to secure from this Congress, and as well, being a champion of physician-owned hospitals. Because I do believe that physicians have a high level, an acuteness of their concern for their patient. Maybe it is also because in the last decade I've had to tend to ailing parents, both of whom I lost, and have seen doctors up close and personal dealing with one of the most difficult times in any child's life.

This is not about a fight of one side or another regarding doctors, and my constituents have been kind enough to give me time here to have gone through these debates over and over again. Let me just say very quickly: I am glad the Affordable Care Act is in place, because what we're celebrating today, as we talk about H.R. 5, is that women will not be dropped from insurance when they get sick or pregnant; insurance companies will not require women to obtain preauthorization for referral for access to an OB/GYN; millions of older women with chronic conditions will not be banned from care; 279,000 constituents in the 18th Congressional District will have improved employee health care; 187,000 uninsured in the 18th Congressional District will now have access to health care; and my hospitals, my public hospitals, my Texas Children's Hospital, St. Luke's, Methodist, Ben Taub, M.D. Anderson will be able to secure compensation in uncompensated care. I celebrate the Affordable Care Act.

But today we're discussing legislation that has already received a veto notice from the President, but we're here on the floor of the House discussing H.R. 5 and ignoring the fact that the Affordable Care Act has already confirmed health care is vital to America, and we in the Congress must protect it.

By the way, the Affordable Care Act is a preserver of Medicare and strengthens Medicare.

But let me tell you what we are facing with this legislation that is anchored with the component dealing with medical malpractice. We have

seen documentation across States that, in fact, medical malpractice is an insurance issue. And even when there is an attempt to, in essence, dumb down the recovery, we have seen that the insurance companies do not, in essence, reward the physicians. Insurance premiums are still high, high, high, high, high. How do I know? You can go to the State of Texas and ask physicians are their insurance premiums such that they're celebrating today. Yes, there were some measured declines, but they are paying high insurance premiums.

Now, in the findings of H.R. 5, our friends cite the Commerce Clause and indicate that Congress has a right to write this bill on health care because of the Commerce Clause. As I understand it, many are pursuing the challenge of the Affordable Care Act, suggesting we had no authority. But in their own bill, the findings cite interstate commerce as the basis of writing this bill. But there are some friends over there that just caught it, and one of the amendments from another gentleman from Georgia strikes the findings. This is a case of ``have your cake and eat it too'' because they know that tort law has, for a long time, been the prerogative of States.

So to cite President Reagan when he gave this seminal talk on tort law in 1986, his words:

So over the years, tort law has helped us drive the

negligent out of the marketplace. This, in turn, has

permitted legitimate economic innovation to take its course

and raise living standards throughout the Nation.

So the President agrees that tort law drives the negligent out of the arena. He then goes on to say, as he put together this task force:

To be sure, much tort law would remain to be reformed by

the 50 States, not the Federal Government. And in our Federal

system of government, this is only right.

So my friends cannot deny that H.R. 5 implodes State law. It takes away the authority of States. And removing it by some late amendment is not going to make it right. You are going to violate the rights of Colorado, Florida, Illinois, Maryland, Michigan, Texas, and West Virginia that have enacted their own medical malpractice damage caps. You are going to implode the rights of Connecticut, Iowa, New York, Oregon, and Tennessee that have expressly chosen not to limit. And in this bill, if you have not limited it, then you are capped. In this bill, you rid the rights of those States that have not capped, and the flexibility only comes if you have capped and it is higher than what we have, and you obliterate constitutional State law that has its own caps.

So this is not as black-and-white as my good friends would like to make it. We are riding in on the high horse, and we are not?

For example, in my State of Texas, on May 29, 2010, Connie Spears went to a hospital reporting excruciating leg pain. This was all too familiar due to her previous blood clots. The emergency room doctor ran tests and discharged her with a bilateral leg pain. But what really happened is that she had blood clots around a vein filter. She got kidney failure. She went unconscious. To save her life, two legs were amputated. There was definitive negligence. And it is important to note that she sits today with no legs.

What we are suggesting is that we are now intruding into State law, that this individual now, under Federal law, loses noneconomic damages for pain and suffering and the extent of the negligence that was promoted and, as well, faces a Federal hard hat to prevent her from having relief. Now, this is in the State of Texas, and we have tort law reform that many oppose, but it is a State decision.

I offered an amendment that would have carved out an exemption for health care lawsuits for serious and irreversible injury, supported by two of my colleagues, Congressman Hank Johnson and Mr. Quigley. It exempted victims of malpractice that resulted in irreversible injury, including loss of limbs and loss of reproductive ability, from the $250,000 cap. This was not accepted.

What we say today is people like Connie Spears, children, seniors who are limited in their noneconomic damages, now have no basis for punishing those who were blatant in their negligence, no way of dealing in a punitive manner to prevent these kinds of acts from happening and recognizing the loss of limbs of someone who may have been unemployed.

My friends cannot have it both ways, that is, challenging the Affordable Care Act because they say that interstate commerce does not allow us to do good, but yet coming back in their findings to suggest they have the upper hand.

Well, I'm going to join my friend on the other side of the aisle, Mr. Johnson, on states' rights. Today, on H.R. 5, you literally quash and extinguish states' rights; and in the course of doing so, you quash the rights of injured patients, for those that Ronald Reagan said to get negligence out of the marketplace, out of the way of those who need care so that the good can rise up.

So I would make the argument that we're now debating in a conflicted manner. I don't know what the positions of Republicans are. They want to get rid of the Affordable Care Act, which was premised on interstate commerce, the authority of Congress. They come right back at our 2-year anniversary, celebrating people who are living because of the Affordable Care Act, and now want to place their hat on doing this on interstate commerce. I want to know where all the states' rights advocates are and why you are abolishing and eliminating constitutional State law, why you are eliminating statutory law where individual States have expressed their will.

I believe this bill, along with the component that wants to dash the Affordable Care Act, is a bill destined for the President's veto. But more importantly, let me try to understand how we can have our good friends on the other side of the aisle have their cake and eat it too.

I'm celebrating with the celebratory cake of the Affordable Care Act. I don't mind celebrating this Congress' right to help save lives.

How do you put a bill on the floor of the House where you have argued that there is no right for us to be involved in health care, and now you want to dash the rights of those who have been injured through interstate commerce and the Congress of the United States of America? Frankly, the complexity of your argument is such that it makes no sense; and, frankly, I hope that my colleagues will join me and applaud the Affordable Care Act, celebrate the expanded life that we have provided, and also recognize that those individuals who seek remedy in the marketplace, who have been injured by negligence and acts that have been dastardly, are compensated in a fair and just manner. That is all we ask under the Constitution: due process and the rights of all Americans.