Restoring Access to Medication Act of 2012

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

This bill is mainly a smoke screen. It is an effort to cover up the failure, indeed the refusal, of Republicans to act on the key issue facing our Nation: jobs and economic growth.

As ranking member, I sent a letter last Friday to Dave Camp, who chairs the committee with the jurisdiction over the bill before us today, urging action on six major jobs bills within the committee's jurisdiction: extension of the section 48(c) advanced energy manufacturing credit; extension of the production tax credit for wind power and other vital advanced-energy incentives; extension of the highly successful build America bonds program, which financed more than $180 billion in infrastructure investment; extension of the 100 percent bonus depreciation; creation of a 10 percent income tax credit for small businesses that do create new jobs or increase their payroll; an extension of a jobs-related expired provision, such as the R&D tax credit.

The answer: silence and continued inaction by Republicans in this House.

Another bill over which the committee has jurisdiction, the highway bill, remains unacted upon. That bill would mean millions of jobs. No action. The Republican House message on the highway bill is: our way or the highway. And that means no highways.

It is June. There is now the likelihood of no action or none before the construction season is over in numerous States. That inaction is not an accident. It is deliberate. It is implementing the goal stated 20 months ago by the Senate Republican leader:

``The single most important thing we want to achieve is for

President Obama to be a one-term President.''

It is reflected in the recent interview by the House Republican leader. Mr. Cantor said the rest of the year will likely be about ``sending signals, we have huge problems to deal with.''

Sending signals? The American people don't need and want signals. They need for us to take action to strengthen the economic recovery.

We will hear today Republican efforts to describe the bill before us to repeal the tax on medical devices as a jobs bill. What it really is is another Republican effort to repeal health care reform, step by step, costing, in this case, $29 billion.

We Democrats want more Americans to have access to medical devices. Health care reform helps do this by expanding insurance coverage to over 30 million individuals, which indeed will help the growth of and the innovation in the medical device industry. And as was true for other health groups benefiting from increases in health coverage, the medical device industry was asked to help to pay for health care reform so it would be fully paid for, not add to the deficit, as so many Republican measures, but it would be fully paid for.

They signed a letter with others pledging:

``We, as stakeholder representatives, are committed to

doing our part to make reform a reality in order to make the

system more affordable and effective for patients and

purchasers. We stand ready to work with you to accomplish

this goal.''

The first signature on that letter is from and by the President and CEO of the Advanced Medical Technology Association.

Now the Republicans are attempting to give that industry a free pass--a free pass--contrary to their stated commitment. The industry has not proposed any alternative whatsoever to meet that obligation reflected in the letter they signed. There is an effort here to cast repeal of the tax as a small business bill.

The 10 largest companies in this submarket would pay 86 percent of the taxes relating to nondiagnostic devices. According to CRS, the 10 largest companies that manufacture medical devices had total companywide profits on all their lines of businesses, both devices and other products, of $42 billion in 2010, including companies mentioned here, and $48 billion in 2011, and these companies had gross revenues from the sale of medical devices in 2010 of $133 billion.

There was an effort here also to cast the bill as an effort to stop offshoring, but this point needs to be made. It's a fact: The tax applies to all covered devices, including those that are imported. So if anybody thinks they can just move overseas and bring it back here and not pay a tax, they're simply incorrect.

The effort to cast this as a jobs bill involved allegations repeated here during the debate on the rule, which were analyzed by a neutral source and found to be simply erroneous. A Bloomberg group analysis made that clear: ``The study used by Republicans cites no evidence for the job loss claim.''

Further, the study's assumptions, ``conflict with economic research, overstate companies' incentives to move jobs offshore, and ignore the positive effect of new demand'' created by the health care reform law.

Before Rules yesterday, I asked that my substitute be placed in order to allow debate on two real jobs initiatives mentioned in my letter to you, Chairman Camp: a tax credit for employers that expand their payrolls, and an extension of bonus depreciation. Those two provisions would help create hundreds of thousands of jobs, not speculation, but real, including in small businesses. This has not been allowed.

So we have open rules, as we have seen the last few days on some bills, that often mainly result in numerous amendments, shifting some monies from one place to another in an agency, not often helping to create a single job, but a closed rule when it comes to

bringing up provisions helping to create American jobs and economic growth.

This is further evidence of what is really going on here in this Congress, a deliberate effort now increasingly undisguised to close the door on action to engender job creation and economic growth before the election.

November 6 is what is driving the Republican Congress. Politics, not people. That is only not cynical, it is, indeed, pernicious. We owe it to the American people to blow the whistle on this. Too much, indeed, is at stake.

National Women's Law Center,

Washington, DC, June 6, 2012.

Re Vote No on Protect Medical Innovation Act of 2011, H.R.

436.

Dear Representative: The National Women's Law Center writes

in strong opposition to H.R. 436, the Protect Medical

Innovation Act of 2011, because it would undermine a critical

protection in the Affordable Care Act (ACA) and reduce

financial security for women and families. The bill would pay

for the elimination of the modest excise tax on medical

devices and other revenue provisions of the ACA by increasing

the tax liability of individuals and families receiving

premium tax credits through the new insurance exchanges.

The modest excise tax on medical devices is a fair way to

raise revenue to help finance affordable health care coverage

for millions of Americans. The expansion of health care

coverage will benefit a wide range of health-related

industries, including the medical device industry, by

increasing demand for their products. Other industries in the

health sector are contributing to financing an expansion from

which they will profit; it is entirely appropriate to require

the medical device industry to make a contribution as well.

The tax will have minimal impact on consumers, because it

does not apply to medical devices that consumers buy at

retail, such as eyeglasses or hearing aids, and spending on

taxable medical devices represents less than one percent of

total personal health expenditures. And the tax will not

encourage manufacturers to shift production overseas: it

applies equally to imported and domestically produced

devices, and devices produced in the United States for export

are not subject to the tax. Repealing this tax and forgoing

$29 billion in needed revenues would be irresponsible--even

without the outrageous step of imposing this cost directly on

Americans without access to affordable health care coverage.

Increasing the tax liability of individuals and families

receiving premium tax credits for health insurance coverage

is unfair and would reduce coverage for hundreds of thousands

of Americans. The ACA provides premium tax credits to

families with household income at or below 400 percent of

poverty who enroll in coverage through an exchange. An

advance payment of the premium tax credit will go directly to

insurance companies so that the monthly insurance premium

paid by families is reduced, thereby making health coverage

more affordable for millions of families. However, there is a

``reconciliation'' at the end of the year when a family files

taxes to ensure that the right amount of credit was paid to

the insurer on the family's behalf. The ``reconciliation'' is

based on actual household income for the year, while the

advance payment is based on a projection that could be based

on current income or past tax returns. The ACA included an

important protection by including a cap on the amount of

repayment penalty a family would have to pay based on

``reconciliation.''

The proposal expected this week would entirely eliminate

this protection, leaving families vulnerable to an

unaffordable tax bill. Many families will be discouraged from

enrolling in coverage because of the potential tax liability

at the end of the year. Much of the savings from the proposal

are achieved because hundreds of thousands of people are

expected to refuse coverage if the cap is eliminated. Women

will be particularly affected by the elimination of the cap.

Women have lower incomes than men and experience larger

income variability from one year to another. This suggests

women will be more at risk for repayment penalties. Women

also often make the health care decisions for the family and

will be faced with the difficult decision of enrolling in

affordable coverage or forgoing that coverage because of a

potential tax penalty.

The cap on the repayment penalty has already been

increased. Eliminating the cap would eliminate all

protections for families that are doing their best to provide

the right information to the exchange but face mid-year

changes in income or family size. A server in a restaurant

could gain new shifts or be promoted to manager. An employer

may give unexpected bonuses in December. A couple could get

married mid-year without fully understanding the impact on

household income and poverty level. The cap on the repayment

penalty needs to remain in place in order to protect families

and provide the stability promised in the ACA.

We urge you to protect the security of families and the

revenue provisions of the Affordable Care Act so millions of

Americans can receive affordable health care by voting no on

H.R. 436 and any proposal to eliminate the cap on the

repayment penalty.

Very truly yours,

Judy Waxman,

Vice President, Health and Reproductive Rights.

Joan Entmacher,

Vice President, Family Economic Security.

I yield 3 minutes to the distinguished gentleman from California, a senior member of our committee, Mr. Stark.

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

It is now my pleasure to yield 3 minutes to another important member of our committee, the gentleman from Seattle, Washington (Mr. McDermott).

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

I yield the gentleman an additional 1 minute.

Mr. Speaker, I now yield 3 minutes to another very distinguished member of our committee, the gentleman from New Jersey (Mr. Pascrell).

It's now my pleasure to yield 2 minutes to the very distinguished Member from Minnesota (Ms. McCollum).

Mr. Speaker, I now have the privilege of yielding 2 minutes to the gentleman from Pennsylvania (Mr. Critz).

Mr. Speaker, I now yield 3 minutes to another distinguished member of our committee, the gentleman from Texas (Mr. Doggett).

Could you please indicate how much time there is on each side?

I yield myself 30 seconds.

It's the Republicans who've combined these three bills. The Republicans.

And the leader talks about jobs. I wish he would give instructions to the Ways and Means Committee to consider and bring up jobs bills that are just languishing from inaction. We need more than signals. We need action.

I yield 3 minutes to the gentleman from California (Mr. Thompson), a distinguished member of our committee.

It is now my pleasure to yield 3 minutes to another distinguished member of our committee, the gentleman from Massachusetts (Mr. Neal).

I yield myself 30 seconds.

We very much favor the medical device industry. They agreed to pay for health insurance coverage. In 2011, Stryker had revenue of $8.37 billion on these products with a net income of $1.3 billion. Everybody is going to have to participate, as they promised, to make health care work. If everybody ducks out, people will go uninsured.

It is now my privilege to yield 3 minutes to the gentleman from Wisconsin (Mr. Kind).

I yield the gentleman an additional minute.

I yield 1 minute to the gentleman from North Carolina (Mr. Watt).

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

I yield myself the balance of my time.

In a sense, there is much at stake in this debate. If this bill were to become law, it would unravel health care reform. What this industry seems to be asking is a reversal of their commitment to make health care reform work. If this Congress and the President were to say okay, every other industry that participated in saying they pay their share to make it viable, they'd come in line, and there would be no answer to them. In that sense, this debate, this issue is significant.

But in another sense it really isn't. This bill isn't going anywhere. The Senate leadership has already said it's not taking it up. There's been issued a Statement of Administration policy. The recommendation is the President would veto it. There's a certain emptiness to this debate because the bill isn't going anywhere.

The real significance is that it's being brought up despite that, raising the question, Does the majority in this House want a bill that goes somewhere relating to jobs?

The word ``jobs'' has been mentioned here more than any other word. As mentioned earlier, there is no evidence that jobs would be lost, as indicated by the majority.

The only study says that the 43,000 claim is wrong. So what's really at stake here, the significance of this debate is this: Will the majority do more than signal in this session, in its remaining months, or will it take up jobs legislation? I think there's an increasing indication that they, the majority, do not want a jobs bill that will go anywhere.

I mentioned earlier the letter I wrote to the chairman of our committee. I mentioned in there six provisions clearly relating to jobs in America, the 48C Advanced Energy Manufacturing Credit that once had bipartisan support.

The production tax credit for wind power, the Republicans came before the Ways and Means Committee and said, Extend it. But, silence. The Build America Bonds program. It helped to create hundreds and thousands of jobs--$180 billion in infrastructure investment. The 100 percent bonus depreciation that both sides say they support. But nothing but inaction. The proposal by the President for a 10 percent income tax credit for small businesses that could create jobs, not the illusory statements mentioned here. And then the R&D tax credit that the chairman of this committee and I have championed for years--and all we do is have a hearing.

And so this bill raises starkly this issue: Does this majority want bills going nowhere, or will they do more than signal and act to help create jobs that the people of this country badly need. That's the real issue before us today.

I urge a ``no'' vote on this bill on the merits. I urge the majority to start saying ``yes'' to jobs bills for the people of the United States of America.

I yield back the balance of my time.

Mr. Speaker, I yield to the gentleman from Virginia, the majority leader, for the purposes of inquiring about the schedule for the week to come.

I thank the gentleman for that information, and I want to make the comment that the gentleman correctly congratulated the appropriations leadership on his side of the aisle.

I also want to observe that on our side of the aisle there has been cooperation, and there's not been an effort to either delay or dissemble. That is why this process works. That's the way it should work. It hasn't always been that way, as the gentleman knows, but I'm pleased that it is working. I think that's best for our institution, and I think it's best for the country. So I'm pleased at that, as well.

I tell my friend--and he knows this--according to the schedule I have, the House is scheduled to be in session a total of 28 days until the August break and 41 days from now until November.

Of the 41 days available, 10 are 6:30 days in which we come in for an abbreviated evening session which usually takes a half hour to an hour to conclude after afternoon debate on suspension bills.

With the limited time we have available, Mr. Leader, I am very concerned, as the gentleman knows, of the extraordinarily large number of very big fiscal questions that will be coming to roost at the end of this year. My view is that we need to address those. Hopefully, we will address them in a bipartisan way. If we do not address them, we will put the economy at continuing risk.

The Bush tax cuts, as you know, expire as of December 31. The payroll tax cut expires December 31. The sustainable growth rate--which we affectionately refer to as the doc fix--the alternative minimum tax, and the debt limit all come to bear at the end of the year.

In addition to that, the sequester--which I think all of us believe is not the appropriate way to go, but is the way we set up to force us to take action on a comprehensive, big, bold, balanced plan. Unfortunately, the supercommittee was unable to reach agreement on that.

I wanted to say to my friend, the majority leader, I would hope that you would be urging all of us and I would join with you in that effort in urging all of us to be ready to make some tough decisions, but decisions which need to be made in order to stabilize our economy and stabilize the fiscal posture of the United States. I am hopeful that we can reach a credible and sustainable fiscal path for our country.

The only way we are going to do that is if we work together in a bipartisan fashion. The gentleman and I were very successful in working on the Export-Import Bank legislation in a bipartisan fashion in which we got over 300 votes for on the House floor. The gentleman was unable to make the signing but it was signed this week, I think a very positive step forward. I appreciated the gentleman's work on that piece of legislation.

I would like to urge the gentleman that because of the extraordinarily short number of days that we have left to meet, to focus on what I think is going to be what some people call a fiscal train wreck, some people call it a fiscal perfect storm, some people call it a fiscal perfect cliff. Whatever you call it, it clearly will have a great impact on not only the confidence that Americans have in this body and the Senate to work and to make effective plans for meeting that challenge, but also for getting our country on a fiscally sustainable path. I don't know whether the gentleman has any comments on that.

I yield to the gentleman.

I thank the gentleman. I was not trying to make political points or rhetoric in raising the issues that I did. I frankly think that it doesn't get us very far, I would suggest to the majority leader, and we need to get someplace. America expects us to get someplace.

Many of your members have indicated that revenues need to be on the table. The gentleman knows that every bipartisan commission that has dealt with this says revenues need to be on the table. The same entitlements need to be on the table. Neither are easy to deal with, but they must be dealt with if we're going to be responsible stewards of this Nation's finances and this Nation's future.

Political rhetoric is not going to get us there. We all want to help small business, and we believe we have helped small business very substantially. Frankly, if you get into the analysis, small businesses did very well during the Clinton administration under policies that were in place at that point in time.

That aside, we need to deal with this, and I think a number of members on your side have, in fact, indicated that they understand that everything needs to be on the table, and that is what I think as well. I think both sides have things that they don't want to deal with, but Americans expect us to deal with tough things and make tough decisions on behalf of them, on behalf of their children and on behalf of their families.

On small business and economic growth, this leads me to the highway bill. We continue to be very concerned, Mr. Majority Leader, that we have not reached agreement on the highway bill. The Senate was able to reach an overwhelmingly bipartisan agreement on the highway bill, which is a jobs bill.

I was disappointed, and I hope the gentleman was disappointed at the jobs numbers that came out today: 82,000 in the private sector, lost 13,000 in the public sector, net: 69,000 jobs. That does not get us to where we want to be after losing millions and millions of jobs in the previous administration and losing a substantial number of jobs in the administration before. Over the last 26 months, we have grown 4 million jobs, but the hole was very deep, and we're not out of it. If you don't have a job, you know we're not out of it. I would hope that we could at least, with certainly our side believing, that the highway bill is a jobs bill.

Ray LaHood, as I pointed out in the past, a former leader in your party and chairman of a subcommittee in the Appropriations Committee, says that it's a jobs bill but unfortunately concludes that bill is not passing, he believes, for largely political reasons. I hope that's not the case and don't assert it to be the case.

Do you have any idea what kind of progress we're making on the highway bill so that bill can come to the floor before the June 30 expiration of the highway authorization?

I yield to my friend.

I thank the gentleman.

I appreciate his observation. Clearly we don't want to have the authority for the highway bill to expire without action, but I will reiterate my offer to my friend, the majority leader, and say that given the bipartisan, the overwhelming bipartisan, support of the bill that came from the other party, that if we brought that bill to the floor, I would tell the gentleman that we will have the overwhelming, perhaps unanimous support, which would be 190 votes on our side of the aisle for that bill because we believe it is a jobs bill. We believe it will grow the economy, it will put people back to work.

It will give confidence to the American people, as we did with the Export-Import Bank in my view, give confidence to the American people that we can come together and move forward through reaching agreement.

Obviously, the Senate was able to do that. And they did it overwhelmingly, with over half of the Republican caucus voting for it in the Senate and three-quarters of the Senate voting for it.

I would say to my friend, I think that would be a real shot in the arm for the economy. And I agree with the gentleman, certainty is important. Confidence building is important. And if we did that, in my view, and if you could bring half of your caucus to that vote, we would pass that bill overwhelmingly. And I think it would be a very positive step for the economy, very positive step for the confidence of the American people and our economy and put people back to work.

I don't know whether the gentleman wants to comment on that further, but if he does, I will yield to him.

Lastly, if I might, the student loan interest rate, as you know, will go up at the end of this month from 3.4 to 6.8 percent. That will add substantially additional cost to literally millions of students, some thousand dollars of additional cost to most students at a time when we want to make higher education, so necessary for success in our country, available to as many people as we possibly can so we can be competitive worldwide and, from our perspective further, a Make it in America agenda of growing our economy and getting jobs for our people.

I know that there was opposition to that reduction when it was originally on the floor in 2007. I know there was some opposition to it earlier this year. But I also know that I think both you and the Speaker have indicated now that they support that. We passed legislation on this floor which brought that down when there was, obviously, very substantial disagreement and controversy with reference to the funding source, given the preventive health fund that was used to fund the student aid.

Can the gentleman tell me whether or not he believes there's a possibility for us to reach agreement on how to do this? I know the Speaker said this was a ``phony'' fight, but it is a real fight and it will have real consequences if we don't resolve our differences. Can the gentleman comment on what he believes to be the possibility of reaching agreement with the Senate on the student loan bill?

I thank the gentleman.

Just for his information, I would be a very strong opponent of your first option, which continues to want to reduce the take-home pay of Federal employees. Federal employees, under the plans that you have passed through this House, will have already been asked to pay $105 billion in reduction in pay and benefits over 10 years. That's $10 billion per year you're suggesting that our employees have their net take-home pay reduced.

In addition, the additional proposal in your reconciliation bill would add another $78 billion to that, $183 billion in total, or $18.3 billion per year reduction in pay and benefits for Federal employees. The gentleman, in his State, has a lot of those Federal employees. They happen to be civilian employees.

I know the gentleman supported the pay raise for the military personnel, which I supported as well. The gentleman is aware that largely, through my tenure in the Congress, we've treated our civilian employees and our military employees with parity. I would hope that the gentleman would not think of continuing to go to the Federal employee, as we go to no other employees, and the gentleman is not interested in asking anybody else to participate more in paying for this in terms of revenues. But your side has been continuing to propose reducing the pay and benefits of the Federal employees.

My view is, and I have said this publicly, that if we can reach a big, bold, balanced deal and it's balanced--but just going to one pocket, one group of people, who studies show, depending upon the level you're working at, many are not paid comparably to their private sector, some others are, is not a fair, balanced way to proceed. I would hope that that option would be not on the table. I know the administration put it on the table for a larger deal, but I'm going to urge that that not be an option.

I know that I have talked to some of your side from your State who believe that's not an option that ought to be pursued. As a matter of fact, one of them voted against the MilCon bill yesterday because of a provision dealing with further reducing the net take-home pay for Federal employees.

So I would hope that would not be an option, and I would hope that we can reach an option so we can contain the cost of college for young people, because that's not only good for them, it's good for the competitive stature of the United States of America.

With respect to the reconciliation bill that you mentioned, you mentioned the fact that you were dealing with the deficit. In fact, as the gentleman knows, in terms of your health care provisions, they do not, within the next 20 years, get the Federal budget to balance in the Ryan budget. So although you deal with that in some respects, it doesn't get us to balance and therefore does not, in my opinion, give the confidence and certainty that the American economy needs and that American citizens need.

I want to ask the gentleman, lastly, if he expects all 12 appropriations bills--I know we're going to do Energy and Water; we've now already done two of our bills--whether or not he expects all 12 appropriations bills to be on the floor, considered, and completed prior to the August break.

I don't want to interrupt, other than to clarify.

As I understand the two options, one was the option of making additional--in the letter I read. Maybe I'm incorrect. If you can correct me.

I thank the gentleman for his clarification.

I thank the gentleman for that information, and I want to say to the gentleman that I disagree that there is no plan. Mr. Van Hollen, the ranking member of the Budget Committee, did in fact have a plan, presented that plan, and it was voted on on the floor of the House. It did not prevail, but that is a plan which, frankly, was a more balanced plan from our perspective. Obviously, the House did not agree with that. But it is a more balanced plan that would have reached balance in fact more quickly, I believe, than the Ryan plan.

So we do have a plan. We presented that plan. We offered it on the House floor. I voted for that plan. The overwhelming majority of the party on this side of the aisle voted for that plan. So there is a plan, so I think the gentleman is not correct in saying that we haven't offered a plan. We have; the plan has not passed, the gentleman is absolutely correct on that. The Senate and the House have not agreed on a plan. I'm not sure that they will be able to agree on a plan. I think that's unfortunate, but perhaps we can agree on the appropriations bills.

We are hopeful that the appropriations bills will be agreed upon consistent with the agreement that we thought we had at the funding levels of $1.047 trillion for discretionary spending. The bills that have been offered are closer to that number than I think we will find as later bills come, we don't know that, but that is the speculation. The Senate has agreed that we ought to mark up to that figure, but we haven't marked up to that figure in the appropriations bills. But if we complete the appropriations bills, as the gentleman says he wants to do, I think it would be good to do.

Is it the gentleman's perspective that we will mark to $1.047 trillion or $1.028 trillion? That's a $19 billion difference, a substantial difference, we understand that. In the Senate, the Republicans and Democrats have agreed to mark to the higher number. Can the gentleman comment on whether or not at the end of the day we'll be able to get agreement on the agreement that we thought we had in the Budget Control Act?

I don't have a rebuttal to that, so I will yield back my time.

Mr. Speaker, pursuant to House Resolution 679, I call up the bill (H.R. 436) to amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and ask for its immediate consideration.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days to revise and extend their remarks and to include extraneous material on H.R. 436.

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

I come to the floor today in support of H.R. 436, the Health Care Cost Reduction Act of 2012.

This bill would repeal two of the harmful tax hikes contained in the Democrats' health care law: the medical device tax and restrictions on using health-related savings accounts for over-the-counter medication.

The legislation also includes a provision that will increase flexibility for health care consumers who use flexible spending arrangements. All are fully paid for by recouping overpayments of taxpayer-funded subsidies used to purchase health care in the government-run exchanges. Notably, every one of these provisions has bipartisan support.

As a result of ObamaCare, beginning in 2013, a 2.3 percent tax will be imposed on the sale of medical devices by manufacturers or importers. This tax will increase the effective tax rate for many medical technology companies, threatening higher costs, job loss, and reduced investment here at home. One study predicts that as many as 43,000 American jobs are at risk if this goes into place.

A recent Washington Post piece by George Will reinforced the threat to job creation and investment, noting that Zimmer--based in Indiana-- is laying off 450 workers and taking a $50 million charge against earnings; Medtronic expects an annual charge against earnings of $175 million; and ZOLL Medical Corporation's CEO, Rich Packer, says the tax will impact the company's investment in research and development, stating that means fewer jobs for engineers. Plain and simple, this tax hike is a job killer, and it must be repealed. I commend committee member Erik Paulsen for introducing this legislation.

Another ObamaCare tax increase, the medicine-cabinet tax, imposes new restrictions on the purchase of over-the-counter medications through tax-advantaged accounts used to pay for health care-related needs. Because of the Democrats' health care law, patients must now get a prescription from a physician if they want to use these accounts to pay for over-the-counter medications. The ban affects everyday lives. It prevents a mom from using her FSA in the middle of the night to buy cough medicine for her sick child without a prescription. It also leaves doctors saddled with unnecessary appointments to get a prescription so that a parent can use their FSA to buy Claritin for their son's allergies.

One study estimates that even eliminating half of these unnecessary appointments could save patients time and the health care system more than 20 million visits each year, reaping a savings of more than $5 billion. These new restrictions must be repealed, and I'm happy that the provision introduced by committee member Lynn Jenkins is being considered today.

The last provision is a new approach that allows consumers the freedom and flexibility to keep more of their money. Under current law, employees' FSA balances must be spent by the end of the year or they will forfeit any unused balance back to their employers under the use- it-or-lose-it rule. Such a rule encourages wasteful and needless spending at the end of the year. This legislation would allow participants to cash out up to $500 in FSA balances, and those funds would be treated as regular taxable wages.

Allowing Americans to keep more of their hard-earned dollars in these difficult times is a commonsense goal that should be widely supported. This provision, championed by Dr. Boustany, is a commonsense one; and I urge its passage.

Finally, I would like to take just a moment to talk about the offset for this legislation, asking those who receive higher tax payer-funded premium subsidies than they are eligible to receive to repay all of the overpayment. Let me be clear: this is a bipartisan offset. Increasing the amount of overpayments to be repaid was a proposal first put forward by congressional Democrats in the 2010 Medicare doc-fix legislation which passed the Democrat-controlled House 409 2. Such an offset was used again when the House passed and the President signed the 1099 repeal last year and more than 70 Democrats supported that bill. In fact, Health and Human Services Secretary Sebelius said:

Paying back subsidy overpayments makes it fairer for all

taxpayers.

This legislation, and the provisions included here, are supported by job creators big and small, patient advocates, senior organizations, and physician groups. I urge my colleagues to join me in supporting these groups by voting for the Health Care Cost Reduction Act.

With that, Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield 2\1/2\ minutes to a distinguished member of the Ways and Means Committee, Mr. Paulsen of Minnesota.

I yield 2\1/2\ minutes to a distinguished member of the Ways and Means Committee, the gentlewoman from Kansas (Ms. Jenkins).

I yield 2\1/2\ minutes to a distinguished member of the Ways and Means Committee, the gentleman from Louisiana, Dr. Boustany.

I yield an additional 30 seconds to the gentleman.

Mr. Speaker, at this time I yield 2 minutes to the distinguished chairman of the Health Subcommittee, the gentleman from California (Mr. Herger).

At this time I yield 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 15 seconds.

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

Mr. Speaker, I yield 1 minute to the distinguished majority leader, the gentleman from Virginia (Mr. Cantor).

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

At this time, I yield 2 minutes to the distinguished chairman of the Energy and Commerce Committee, the gentleman from Michigan (Mr. Upton).

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

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

At this time, I yield 1 minute to the distinguished gentleman from Illinois (Mr. Dold).

At this time, I yield 1 minute to the distinguished gentleman from California (Mr. Bilbray).

I yield the gentleman an additional 30 seconds.

Mr. Speaker, at this time, I yield 1 minute to the distinguished gentleman from Virginia (Mr. Hurt).

Mr. Speaker, I yield 1 minute to the distinguished gentleman from Illinois (Mr. Schilling).

Mr. Speaker, I yield 1 minute to the distinguished gentleman from Ohio (Mr. Turner).

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

I yield 2 minutes to the distinguished gentlewoman from Washington (Mrs. McMorris Rodgers).

At this time we have no further speakers and are prepared to close, if the gentleman is prepared to close.

I yield myself such time as I may consume.

I would just say to my friend from Michigan that we in the committee are in the process of reviewing all of the tax extenders. There's going to be about a hundred of them that expire at the end of the year, research and development being one of them--one I, obviously, have supported over the past.

Given our budget situation and given the record deficits run up by this administration, we're taking a close look at all of these provisions to make sure that they're justified, to make sure that they really bring economic benefits and jobs to this country, not just pass them along because that's what's been done in the past, but to really take our oversight responsibilities, review responsibilities seriously to make sure the things that we're doing are efficient, are effective, and really get to the core of how do we get this economy moving again.

We had the jobs numbers last Friday. They were abysmal. Clearly, the economic policies of this administration have been a failure. We're, obviously, trying to address some of the other policies of this administration that aren't going to work. And clearly, there are flaws in the health care bill. We've had bipartisan support to fix some of them, like repealing that onerous 1099 provision that would have put a wet blanket over all small businesses as they try to file paperwork on every expenditure over $600. It was a ridiculous provision. We had strong bipartisan support to repeal it. The President signed it. That is law.

We're now looking at today what we can do to improve other problems in this health care bill. One of them, clearly, is we need to help people save and allow them to afford the kinds of medications they need. For example, they tax over-the-counter medications by saying you can't use your tax-free savings account to buy cough syrup for your sick child.

So what's happening is many people are going to doctors. They're actually having to get a prescription so they can use their flexible spending account, the account that they have set aside to save for their medical needs. And don't we want parents to be able to try to find a least-cost alternative? If cough syrup will fix the problem that their child is having and meet their medical need, shouldn't we do that first, before going to the ER or before going to get a prescription? Again, what we want to do is keep parents in the driver's seat. Let them make the medical decisions that effect them and their children.

So we believe that it's so important that we allow over-the-counter medicines to be purchased out of an FSA. That is just a critical thing. And that has had strong bipartisan support.

The other issue is regarding medical devices. Clearly, taxing the medical devices is going to do one of two things. It's going to cost jobs. As Stryker Corporation in my home State of Michigan says, it's responsible for about a thousand layoffs as they try to plan for the future. Or, it's going to raise costs. Either one is a bad choice for those people who have medical needs that they need to meet.

And the last provision in this is, can people keep some of the money in their health care or flexible spending account if they don't have all their medical needs requiring the use of money out of that account? Can they save

some of it, or do they have to use it or lose it and buy extraneous things or things they don't really need. What this bill would do is say you can keep some of those dollars--up to $500. You would pay tax on it. And that means that if you've overestimated what your medical needs are, you can get some of those dollars back and use those. Again, it's your wages. You've put it in there. It's yours. You should be able to get it back.

I think these are all strong provisions. They've all had good bipartisan support, both for the substance of them as well as for the pay-for in the bill. That has had strong bipartisan support as well.

So I would urge support for this legislation. I do think it has a lot of support in the Senate as well, and I think we're going to see this legislation move forward. So I urge a ``yes'' vote, and I yield back the balance of my time.

I thank the gentleman from Maryland, the Democratic whip, for yielding.

Mr. Speaker, on Monday the House is not in session. On Tuesday the House will meet at noon for morning-hour and 2 p.m. for legislative business. Votes will be postponed until 6:30 p.m. On Wednesday and Thursday, the House will meet at 10 a.m. for morning-hour and noon for legislative business. On Friday, the House will meet at 9 a.m. for legislative business. The last votes of the week are expected no later than 3 p.m.

Mr. Speaker, the House will consider a number of bills under suspension of the rules, a complete list of which will be announced by the close of business today. I expect the majority of these bills to come from the Natural Resources Committee, and I want to thank Chairman Doc Hastings and his staff for their tireless work in assisting Members on both sides of the aisle with their bills to responsibly remove Federal red tape that stands in the way of local economic development.

Members are also advised that the House will resume consideration of H.R. 5325, the Energy and Water Development Appropriations Act, on Tuesday, our first day back next week. Those wishing to offer amendments to the bill should be prepared to do so as soon as they return to Washington.

The House may also consider two additional appropriations bills next week: H.R. 5855, the Department of Homeland Security Appropriations Act, sponsored by Representative Robert Aderholt; and H.R. 5882, the Legislative Branch Appropriations Act, sponsored by Representative Ander Crenshaw. Chairman Hal Rogers and the entire Appropriations Committee on both sides of the aisle should be congratulated for helping to restore the open process of allocating and prioritizing the Nation's spending.

Finally, Mr. Speaker, the House will consider H.R. 436, the Protect Medical Innovation Act, a very important bill for jobs and innovation in the medical device industry, that Representative Erik Paulsen is sponsoring. The Paulsen bill will be combined with H.R. 5842, the Restoring Access to Medication Act, sponsored by Representative Lynn Jenkins, and H.R. 1004, the Medical FSA Improvement Act, sponsored by Representative Charles Boustany.

I thank the gentleman.

I agree with him that all of us should be very focused on the months ahead as we approach the date at which this country will, by operation of law, experience the largest tax increase in its history, that sequester will be imposed, that we perhaps will face another debt ceiling vote as well as many of the items the gentleman mentioned. I think all of us understand the gravity of those issues.

Mr. Speaker, I think we have also seen in operation around here, together with the White House, the difficulties that the two sides have had coming together on two very important issues that run throughout all of the matters that the gentleman mentioned, and those two issues are health care and taxes.

As the gentleman knows, we have put forward a solution to the health care entitlement issue, which is the disproportionate cause of the unfunded liabilities of the Federal budget. The gentleman, the President, and his party have rejected our solution that has been validated by the Congressional Budget Office as an actual fix to the deficit.

To date we have not seen any counterproposal with the gentleman, his party, or the President coming to the table saying here's how we would fix it. All we continue to hear, Mr. Speaker, is we need to raise taxes, and we need to raise more taxes on people who have been successful.

The gentleman knows that those are the two issues, the taxes and the health care fix, that we've just had real difficulty in trying to come together. I would say to the gentleman we remain ready to work with him and his colleagues on that other side of the aisle to try and produce a result for the American people so we can re-inject some certainty back into the minds of the American people that the economy is going to get better.

Again, we tried to focus on issues having to do with growth in the private sector. How do we speak to that small businessman or -woman who's having difficulty now assessing what his or her taxes are going to be? How do we speak to that working mother there when she questions whether her health care will still be available given the uncertainty around the Obama health care bill?

These are the kinds of things we are trying to work together on. So many other things elude us because the gulf is so wide philosophically in dealing with taxes and health care.

Mr. Speaker, we remain ready to work with the gentleman. We share the concern about what lies ahead.

Mr. Speaker, I would say to the gentleman, as he knows, the House has passed its bill, the Senate has passed theirs, conferees have been appointed, and obviously we're very mindful, as you see, of the expiration of the current authorizing language and law. We are prepared to make sure that there is no stoppage of transportation programming and funding, all

the while desiring a much longer term solution to the problem.

I think the problem remains, as the gentleman knows, just not enough money to address all the things that the country is experiencing in terms of the needs for roads and infrastructure repair, as well as the needed expansion. As the gentleman knows, we all are mindful of the limited resources that are available to address these needs.

Just trying to prioritize, I am hopeful that the conference committee can come to a solution prior to the expiration of the authorizing language in place right now. Again, we are very mindful. We don't want to allow for shutdown of any program at the end of this month.

Thank you.

Mr. Speaker, I say to the gentleman I have no further comment.

I would say to the gentleman that the Speaker and I, together with the Republican leader and whip in the Senate, have sent a letter to the President--perhaps the gentleman has seen it--suggesting a way forward on the issue of student loans so that there will not be an expiration of the subsidy provided to students.

We suggested two options to allow for the continuation of the lower rates for students to be paid for by provisions which the President has suggested that he would agree to. The two options are to limit the length of in-school interest subsidy and the other is to revise the Medicaid provider tax threshold and to phase it down so that we can actually achieve some savings so that we can allow for the continuation of the subsidized rates for students who are struggling on their tuition bills.

These are two options that we suggest. They are bipartisan in nature. There shouldn't be any reason why we couldn't get this done prior to the expiration of the current law.

If I could, Mr. Speaker, just point the gentleman's attention back to the student loan issue.

I specifically did not offer up the option of the Federal employee pay-for because I do know that we have a difference on that. So the gentleman explained the differences. We understand

that. That's why we're trying to avoid differences and come together where we can agree, which is why I discussed the two other provisions which are bipartisan in nature and that the President has said he supports, which could, in a responsible fashion, allow us to continue the lower rates.

Mr. Speaker, there were two options: One was the Federal employee pay-for in and of itself, the reductions in the size of the Federal Government, would have taken care of the pay-for, if you will, for the student loan issue. The other option was composed of two different provisions, both of which are bipartisan in nature and the President says he supports. One of those is to limit the length of in- school interest subsidies; the other was to revise the Medicaid provider tax threshold. It was those two components that comprise option two. That is my point.

I'm not quite sure about the note he made about our budget not balancing within the budget window. I would say to the gentleman, we understand that, but it is a plan that we could adopt that would provide a blueprint for getting us back on track as far as managing down the debt and deficit. And my point originally was, Mr. Speaker, there's been no such plan, there's been no such proffer from the President or the gentleman's side of the aisle.

So in order for us to move forward, we need participation from both sides. We can't just have one side providing a solution without the ability to get that solution put into place because the gentleman's party is in control in the other body and in the White House. So how do we go about trying to find commonality if there is no proffer of solution? That was my point, Mr. Speaker. And there has been no solution, balanced or not, provided by the other side.

And I would say lastly to the gentleman's inquiry about the appropriations process, we certainly maintain the position we'd like to see all of our bills brought to the floor through regular order, consistent with the Speaker's policy of an open debate that we have seen thus far in the appropriations bills. We had a successful completion yesterday, and we are continuing in the Energy and Water appropriations measure today and as we come back next week.

Mr. Speaker, I would just say to the gentleman, he and I have discussed this before in these colloquies, and I would suggest turning attention to a Senate that hasn't even begun considering its appropriations bills, to suggest that we would come to an agreement with the Senate, I think, you know, the Senate has got to really start to do its work as far as the appropriations process is concerned.

I yield back.

I thank the ranking member on the Ways and Means Committee for yielding me this time.

Mr. Speaker, in the waning days of the work we were doing to get the Affordable Care Act in shape for consideration before the entire Congress, I wasn't an enthusiastic supporter of the medical device manufacturing tax as one of the pay-fors in order to pay for health care reform. I, however, agreed with the President wholeheartedly that health care reform had to be fully paid for. In fact, the idea was to pay for it, and then some, so that we had the ability to start reducing our budget deficits out into the future.

Because of the work that was done and because of the hard negotiations and the tradeoffs that were made, the Congressional Budget Office, in its analysis of the Affordable Care Act when it passed, said it would reduce the budget deficit by over $1.2 trillion over the next 20 years. Now, that is a significant achievement--that we are able to start reforming a health care system in desperate need of reform, pay for it at the same time, work to improve the quality of care and the access of care for 33 million uninsured Americans, but also start bending the cost curve in healthcare.

I was concerned about the medical device tax as an element of the pay-for, however, because of the vital role that the medical device industry has in our economy. They play an important role when it comes to job creation. They enjoy certain competitive advantages here in the United States market. I was concerned about the tax applying to the sales of the products as opposed to profits because of the impact it will have on smaller manufacturers, which operate on a much smaller margin.

That's why I support the legislation before us today, but I do so under the proviso and with the understanding that the pay-for that is being used right now is controversial on our side. I don't think it's the ideal pay-for. I don't believe that it's going to be the pay-for that the Senate would consider if it takes this measure up. It certainly won't be the pay-for that the President will feel comfortable signing into law. So there is going to be additional work that we're going to have to do together to try to find an acceptable bipartisan pay-for if we're going to repeal this tax on an important industry in our country.

I would also submit to my colleagues on the other side that there are many proposals under the Affordable Care Act that have enjoyed wide bipartisan support in the past, proposals that can help find savings in the healthcare system. They include the build-out of the

health information technology system that our health care providers desperately need, which will not only improve the efficiency of care delivered and reduce medical errors, but will finally start collecting that crucial data so we know better what works and what doesn't work in the delivery of health care. There are delivery system reforms in the health care reform bill that are already proving effective and that lead us towards a system that is more integrated, that is more coordinated, that is patient-focused, thus producing a much better outcome of care but at a better price.

Ultimately, we have to continue working together to change the way we pay for health care in this country so that it's based on the value--or the quality or outcome of care that's given--and no longer on the volume of services and tests and things that are done regardless of the results. There has been wide bipartisan agreement in the past over these issues which are included in the Affordable Care Act, but you would never guess it by listening to the terms of the debate today.

While I support the legislation and what it's trying to accomplish here, I still think, following today's debate, there is going to be a lot more work that we're going to have to do in dealing with the other side of the Capitol, with the Senate, as far as coming up with acceptable pay-fors, in its mind, and also in working with this administration.

So hopefully we can reduce this tax burden on an important industry. But we can do it in a more reasonable and commonsense fashion so we don't jeopardize the health care access of over 350,000 Americans, which may be adversely impacted with this ``true-up'' provision, that is being used today to pay for the repeal of this revenue measure.

I thank my colleague for the time I was yielded.