H.Res. 269

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 269 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentleman from Massachusetts (Mr. McGovern), pending which I yield myself such time as I may consume. During consideration of this resolution, all time yielded is for the purpose of debate only.

General Leave

Mr. Speaker, I ask unanimous consent that all Members have 5 legislative days to revise and extend their remarks.

House Resolution 269 provides for a modified open rule providing for consideration of H.R. 1216, which amends the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from mandatory spending to an authorization of appropriations; H.R. 1540, the National Defense Authorization Act; and same-day consideration of a rule to consider extending certain provisions of the USA PATRIOT Act. Mr. Speaker, this is the seventh modified open rule that the House Republican majority has offered this Congress, compared to the liberal Democrats' one modified open rule during the entire 111th Congress.

The first underlying bill today, H.R. 1216, continues the fulfillment of the Republican Pledge to America and illustrates that once again Republicans are keeping our promises to the American people to cut Federal spending. The American people want transparency of Washington's spending of hard-earned taxpayer dollars. In an act of gross irresponsibility, the Federal Government is spending $1 out of $4 of gross domestic product.

We hear the term ``Federal money'' as though it is manna from heaven. Let me dispel that misconception, Mr. Speaker. The Federal Government has only the money it takes away from hardworking American families through taxes or the money it borrows. As a Nation, we are currently borrowing 43 cents for every dollar spent at the Federal level.

Some argue that to balance the Federal Government and pay down our debt, we should raise taxes. As a fiscal conservative, I have to disagree. Raising taxes on hardworking Americans and job creators is simply a way to pass the blame. We must rein in out-of-control Washington spending and put an end to it. The American people are sick and tired of reckless government spending and Washington's disregard for basic budgeting principles of living within its means. This is one of the many reasons I urge my colleagues to support this rule and the underlying bill before us today, Mr. Speaker.

H.R. 1216 restores congressional oversight to Federal spending by ending the autopilot spending for physician residency programs at teaching health centers and restoring it to the annual appropriations process. When a program is put on autopilot, Congress abdicates its authority to unelected bureaucrats and takes a hands-off approach. House Republicans are committed to ending that approach to Federal spending and ensuring that government programs are accountable for how they are spending money. No longer will we accept politically popular excuses. Each program must prove that it is a wise steward of taxpayer dollars. If Congress will not address out-of-control spending now, we are passing the buck to our children and grandchildren.

Therefore, I commend my Republican colleagues at the House Energy and Commerce Committee for seeking to end mandatory or autopilot funding for programs in the liberal Democrats' government takeover of health care. Because the liberal elites knew their government takeover of health care was unpopular and would likely have consequences at the ballot box, they included $105 billion in mandatory taxpayer spending in the law itself to protect their favorite programs.

Let me take a moment, Mr. Speaker, to explain the difference between discretionary and mandatory government spending. Discretionary spending is appropriated by Congress annually and, therefore, subject to congressional oversight and review. Discretionary spending allows Members of Congress the opportunity to be wise stewards of the taxpayers' money by not funding ineffective or duplicative programs. On the contrary, mandatory spending operates irrespective of congressional appropriations and must be spent whether we have the money or not. The most recognized mandatory spending programs are Medicare, Medicaid and Social Security which operate on autopilot and have not been subject to congressional oversight from year to year as funds automatically stream from the Treasury to anyone who qualifies for a particular benefit.

It cannot be emphasized enough that the liberal elites in Washington chose to hastily ram through their government takeover of health care with no regard for the staunch opposition of the American people. The audacity of an elected official or, worse, an unelected bureaucrat basically saying to a taxpayer that he or she knows how to spend the taxpayer's money better than the individual taxpayer is appalling. That is what the ruling liberal elites in Washington did when they chose to forgo the annual appropriations, also known as oversight, process by putting their favorite programs on autopilot under ObamaCare.

Mr. Speaker, it is my firm belief that Washington should not be in the business of picking winners and losers. During committee consideration of the underlying bill, my Republican colleagues rightly pointed out that the liberal Democrats in control last Congress put the funding for residencies at teaching health centers on autopilot but left residency programs at children's hospitals to fend for themselves in the annual appropriations process. In fact, President Obama's FY 2012 budget proposes eliminating funding for residency programs at children's hospitals.

Mr. Speaker, it is hard to understand why residencies at teaching health centers should receive special treatment. Why were these residency programs protected while others languished and were eventually proposed to be eliminated?

This is a classic example of Washington bureaucrats deciding which programs will win and which will lose. As I said earlier, every program should be properly scrutinized by Congress

through the appropriations process and be accountable for how it is spending taxpayer money. While this accountability should always be important, it's even more critical because we're facing the third straight year of trillion dollar deficits. This fiscal year our deficit will be $1.6 trillion.

Mr. Speaker, remember the figure I mentioned earlier about our Nation's borrowing habits? We're borrowing 43 cents of every dollar the Federal Government spends. This translates to a national debt that has now reached more than $14 trillion and has gotten the attention of the American people. If you're having a hard time visualizing $14 trillion, let me put it this way: If America was required to pay back its national debt right now, each citizen--man, woman, and child--would owe more than $46,000.

The simple truth is that we have a spending crisis in this town due in large part to mandatory spending that operates on autopilot. House Republicans are committed to bringing government spending under control, and we're continuing to build on our Pledge to America by restoring congressional oversight and accountability for government programs.

Again, Mr. Speaker, I urge my colleagues to vote for this rule and the underlying bills.

I reserve the balance of my time.

Mr. Speaker, I thank my colleague from Massachusetts for bringing up some issues that need to be responded to.

First of all, let me say he says that we plan to repeal Medicare. It was the

Democrats who, in voting for the health care act that took over health care in this country to the Federal Government, who cut $500 billion from Medicare--a half a trillion dollars. Republicans have made no recommendations to cut Medicare at all. Only the Democrats have voted to do that. Not Republicans.

Republicans want to save Medicare, Mr. Speaker. That is what we are doing. We're recommending that we save Medicare for the future. The Democrats are the only ones who want to repeal Medicare by cutting that money from it.

Let me mention a couple of other things that my colleague has spoken about in terms of underlying bills.

In terms of the Patriot Act, I believe it is the Attorney General, the Democrat Attorney General, Mr. Holder, who has recommended not only that the Patriot Act be renewed, but that all three of these provisions be made permanent. It is coming from that side of the aisle that they want the Patriot Act renewed. So their President is pushing for this.

In terms of borrowing for the war, Mr. Speaker, you know, it is the Federal Government and only the Federal Government that provides for the national defense of this country. That is why we have a Federal Government, Mr. Speaker. It's why we became the United States. No other branch of government can provide for our national security. Every other branch of government, however, can handle health care, can handle education, can handle many of the things that the Federal Government has gotten itself into that it has no business being involved in. So if we had to borrow money, we wouldn't be borrowing money if we weren't in these other things. We would have ample resources to provide for the national defense.

But I would also like to point out to my colleague from Massachusetts that it was a Democratic President who took us into a third war, with no authorization from the Congress. And it is not the Republicans who are creating this problem.

Mr. Speaker, the second bill made in order under this rule is H.R. 1540, the National Defense Authorization Act.

Mr. Speaker, this weekend we will all pause to observe Memorial Day, as we should. As we debate this very important bill, we need to keep in mind the men and women of the Armed Forces and their families. We also need to keep in mind those who have made the ultimate sacrifice in defense of all of our freedoms, including this process of freely debating our laws and the idea of the role of government. We could not be here today without the sacrifices of those who served in the military and kept us a free people. I hope that's what everyone keeps on their mind this weekend when they celebrate Memorial Day.

As James Madison wrote in the Federalist Papers, ``The operations of the Federal Government will be most extensive and important in times of war and danger.'' Our Founding Fathers had a clear view that the primary and central job of the Federal Government was to ``provide for the common defense.'' Providing for the common defense is the mandate of our Constitution. It's not an issue that should divide us in partisan rancor, but unite us as a country that supports our military and provides them with the tools to do their very important job.

One need not look too far back in history to find words that remind us of our responsibility to provide for the common defense. President Ronald Reagan, in his first inaugural address, promised to ``check and reverse the growth of government,'' but also to ``maintain sufficient strength to prevail if need be, knowing that if we do so we will have the best chance of never having to use that strength.'' That message, Mr. Speaker, still holds true today.

Not only does this bill ensure that our troops are properly equipped, but it also provides the men and women of the military and their families with the resources and support they need, deserve, and have earned. The fiscal year 2012 National Defense Authorization Act takes a detailed approach to ensuring that the investments in our national security are in line with our fiscal priorities and realities.

The bill has a clear mandate of fiscal responsibility, transparency, and accountability within the Department of Defense. It also provides incentives to have competition for every taxpayer dollar associated with funding of defense requirements. The bill addresses a wide range of recent policy changes at the Department of Defense, including the repeal of Don't Ask, Don't Tell; reaffirming the Defense of Marriage Act, which protects one man-one woman marriage; as well as ensuring that our military is properly equipped, trained, and staffed for any future threats to our national security.

Just as our men and women in uniform stand ready to defend our country, Congress must also tackle the fiscal crisis facing our Nation. Nothing, Mr. Speaker, is more dangerous to our national security than the crushing debt that our country is in. Many of my colleagues have come to the floor warning that the sky was going to fall and Armageddon would be upon us if we did not raise the debt ceiling. Well, last week we hit the debt ceiling, and guess what? The sky is still up there and we are paying our bills.

History shows that in 1985, 1995, and 2002, Congress delayed raising the debt ceiling for months without an Armageddon-like economic meltdown. Our intent on this side of the aisle is to pay down the debt with fiscally disciplined and responsible budgets that reduce deficit spending. With a system like that in place, there will be no need to continue to raise the debt ceiling and create further financial burdens that could cost each American over $40,000. Imagine a better American future. Imagine what Americans can achieve if we are freed from Washington's debt burden.

On March 16, 2006, a young Senator took the floor in the United States Senate and said, ``The fact that we are here today to debate raising America's debt limit is a sign of leadership failure. It is a sign that the U.S. Government can't pay its own bills. It's a sign we now depend on ongoing financial assistance from foreign countries to finance our government's reckless fiscal policy.'' Mr. Speaker, that Senator voted against raising the debt ceiling, and that Senator was Barack Obama, our current President. As far as that statement goes, I agree with the President that our dependency on foreign funds is reckless and a danger to our national security.

Just as dangerous is the failure to achieve energy security. Republicans strongly believe that energy security depends on domestic energy production. Our friends, the liberal Democrats and President Obama, have actively blocked and delayed American energy production, destroying jobs, raising energy prices, and making the U.S. more reliant on unstable foreign countries for energy. This is hurting American families and small businesses, who are vital to creating the new private sector jobs we so desperately need during this time of high unemployment.

The liberal proposals fail to create jobs in America but help create jobs overseas for the citizens of foreign nations. We need policies that allow us to take advantage of our natural resources and our innovative culture to develop new sources of energy and create jobs here at home.

To date, the Obama administration has pursued an anti-energy agenda, rife with policies that block domestic energy production and destroy jobs. The consequences of this agenda are dire. In the short term, it fuels a rise in gas prices and costs for consumers, and in the long term it limits innovation and stifles economic growth and job creation.

Mr. Speaker, we need to approve this rule which we are debating and the underlying bills so that we can stop the funding of abortions and so that we can fund our military. And we need to look at the other policies that are being promoted by our colleagues on the other side of the aisle and in the White House to see that we can become more secure as a Nation.

I reserve the balance of my time.

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

Mr. Speaker, I need to point out to my colleague from Massachusetts, as I do almost every time that we are on the floor together, and I do enjoy being on the floor with him, that he always brings up the fact that we had a surplus when President Clinton left office. Well, the reason we had a surplus, Mr. Speaker, when President Clinton left office had nothing to do with President Clinton. It had all to do with the fact that we had Republicans in charge of the Congress.

And just before the Democrats took over the Congress in 2007, as my colleague from Massachusetts so well knows, the CBO projected that there would be a surplus in the United States. However, the Democrats took over in January of 2007 and immediately we began running deficits because of their profligate spending.

I would also like to point out to my colleague from Massachusetts, as he so well knows, that the Democrats who are in control of the Senate held a vote last week on whether or not to change the Tax Code in order to disallow incentives that are given to the oil companies for securing oil for this country. And as he knows, again, it's controlled by the Democrats. It was turned down by the Senate.

So I would like to point out to him that Republicans are not responsible for the deficit and Republicans are not responsible for denying legal tax exemptions to oil companies. It is the Democrats who are responsible for that.

I will allow my colleague to make comments, but I won't allow him to rewrite history.

Mr. Speaker, we have great political unrest in the Middle East, and the growing demand from China threatens our ability to secure long-term reserves of oil from foreign entities. That's why we must pursue an alternative energy policy in this country, one that puts to use our domestic supplies and technologies.

Republicans are going to continue to pursue an all-of-the-above energy plan aimed at increasing our domestic production to bring down energy prices while creating jobs here at home and ending our dependence on foreign sources of oil.

What that means, Mr. Speaker, is we believe in conservation, we believe in alternatives, but we also believe in using the resources that the good Lord gave us here in this country which are being denied to the American people by our colleagues on the other side of the aisle. Mr. Speaker, American families cannot wait any longer for relief at the pump. American families cannot wait any longer for increased jobs.

As we head back to our districts for the Memorial Day holiday, it's fitting that we should all give thanks to those who have given their lives in defense of the freedom that we very much cherish. Every day, courageous young men and women from all over America volunteer to serve our country in the military. They do not join for the great pay, luxurious lifestyle and swanky accommodations. They join the military and serve with dignity and honor because they love this country and they love what we stand for. They serve a much higher purpose than themselves. What our troops provide for us can be summarized in one word: America.

We need now to all come together as supporters of the young men and women of the Armed Forces and their families as proud Americans and provide them with the tools and resources that these brave volunteers deserve, which is why my colleagues and I all need to vote for the underlying bill, the Defense authorization bill.

But we also need to vote for the rule, which is going to allow for almost an unlimited number of amendments to be offered, Mr. Speaker, unlike what our colleagues did when they were in charge in the 110th and 111th Congresses.

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

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

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

I want to bring our attention to the upcoming Memorial Day because we are going to be honoring the fallen and praise their service and sacrifice. We need to remember the families of the fallen and reassure them that their sacrifice and the life of that hero was not lost in vain. We are also very proud of our troops who are currently serving, and we want to make sure that they get that message from us in this body, Mr. Speaker.

I would also like to point out to my colleague from Massachusetts that the unemployment rate was 5 percent when they took over the Congress, or approximately 5 percent when they took over Congress in January 2007. Under their control and President Obama's, it reached 10 percent, and has stayed at around 9 percent while they were in control. So I want to again make it clear that we have worked hard to make the economy work again, and we are going to continue that.

Mr. Speaker, although I have said it also before, it bears repeating: Americans are sick and tired of reckless government spending, creating only government jobs which hurts our overall economy and creates high unemployment. Americans are deeply concerned about the outrageous level of Federal debt. Our constituents are concerned about the piece of our economy that is now owned by other countries like China. They are very concerned about the fact that so much of our tax dollars, the tax dollars they pay, go toward paying interest on the debt instead of using it for the country's immediate needs.

Mr. Speaker, that is why Americans are looking at the new House Republican majority for real answers to their concerns. After 4 years of a complete lack of leadership in Congress under the Democrats, we have rolled up our sleeves and are making the tough decisions to get our economy and fiscal house back in shape. The Federal Government must learn to live within its means and be accountable for how it spends taxpayer money.

House Republicans are continuing to fulfill our pledge to America and keep the promises we made to the American people before the election last November. I urge my colleagues to vote in favor of congressional oversight and against special interests by voting in favor of this rule and the underlying bills.

The material referred to previously by Mr. McGovern is as follows:

An Amendment to H. Res. 269 Offered by Mr. McGovern

At the end of the resolution, add the following new

sections:

Sec. 4. Immediately upon adoption of this resolution the

Speaker shall, pursuant to clause 2(b) of rule XVIII, declare

the House resolved into the Committee of the Whole House on

the state of the Union for consideration of the bill (H.R.

964) to protect consumers from price-gouging of gasoline and

other fuels, and for other purposes. The first

reading of the bill shall be dispensed with. All points of

order against consideration of the bill are waived. General

debate shall be confined to the bill and shall not exceed one

hour equally divided and controlled by the chair and ranking

minority member of the Committee on Energy and Commerce.

After general debate the bill shall be considered for

amendment under the five-minute rule. All points of order

against provisions in the bill are waived. At the conclusion

of consideration of the bill for amendment the Committee

shall rise and report the bill to the House with such

amendments as may have been adopted. The previous question

shall be considered as ordered on the bill and amendments

thereto to final passage without intervening motion except

one motion to recommit with or without instructions. If the

Committee of the Whole rises and reports that it has come to

no resolution on the bill, then on the next legislative day

the House shall, immediately after the third daily order of

business under clause 1 of rule XIV, resolve into the

Committee of the Whole for further consideration of the bill.

Sec. 5. Clause 1(c) of rule XIX shall not apply to the

consideration of the bill specified in section 4 of this

resolution.

I yield back the balance of my time, and I move the previous question on the resolution.

I yield myself such time as I may consume.

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

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

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

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

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

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

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

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

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

I reserve the balance of my time.

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

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

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

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

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

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

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

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

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

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

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

I reserve the balance of my time.

Mr. Chairman, I yield myself 1 minute.

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

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

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

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

I reserve the balance of my time.

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

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

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

I yield the gentleman 1 additional minute.

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

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

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

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

I reserve the balance of my time.

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

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

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

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

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

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

I yield back the balance of my time.

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

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

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

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

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

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

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

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

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

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

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

I yield back the balance of my time.

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

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

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

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

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

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

Madam Chair, I move to strike the last word.

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

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

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

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

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

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

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

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

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

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

I yield myself such time as I may consume.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Chairman, I yield myself 15 seconds.

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

I reserve the balance of my time.

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

I yield myself such time as I may consume.

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

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

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

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

I reserve the balance of my time.

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

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

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

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

I reserve the balance of my time.

Will the gentleman yield?

I thank the gentleman for yielding.

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

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

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

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

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

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

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

I reserve the balance of my time.

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

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

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

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

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

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

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

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

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

HHS Announces New Teaching Health Centers Graduate Medical Education

Program

Eleven centers will support primary care residency training in

community-based settings

HHS Secretary Kathleen Sebelius today announced the

designation of 11 new Teaching Health Centers in the Teaching

Health Center Graduate Medical Education program, a 5-year

program that will support an increased number of primary care

medical and dental residents trained in community-based

settings across the country. These Teaching Health Centers

will be supported by funds made available through the

Affordable Care Act and will help address the need to train

primary care physicians and dentists in our nation's

communities.

With the funds, these Teaching Health Centers can seek

additional primary care residents through the National

Resident Matching program this month and will train 50

additional resident full-time equivalents beginning in July

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

awarded this first program year, in future years the annual

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

as additional residents. These investments provide an

important platform for expanding the primary care workforce

and creating more opportunities to prepare physicians to

practice primary care in community-based settings, while

ensuring primary care services are available to our nation's

most underserved communities.

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

our mission to strengthen the nation's primary care workforce

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

said Secretary Sebelius.

The new Teaching Health Centers are distributed around the

nation and will train residents in family medicine, internal

medicine, and general dentistry. Teaching Health Centers will

receive up to 5 years of ongoing support for the costs

associated with training primary care physicians and

dentists. HHS' Health Resources and Services Administration

(HRSA) will administer the program.

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

training to primary care medical and dental residents, but

also motivates them to practice in underserved areas after

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

Madam Chair, I move to strike the last word.

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

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

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

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

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

I yield back the balance of my time.

Mr. Speaker, I want to thank the gentlelady from North Carolina and my friend, Dr. Foxx, for yielding me the customary 30 minutes, and I yield myself such time as I may consume.

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

Mr. Speaker, this rule allows for the consideration of H.R. 1216, the Graduate Medical Education Direct Spending Repeal Act, and general debate for H.R. 1540, the National Defense Authorization Act for Fiscal Year 2012, and this rule also allows for a martial law consideration of the reauthorization of the Patriot Act sometime this week.

Frankly, Mr. Speaker, this is a disappointing rule. While I have no problem with a rule providing for general debate for the Defense authorization bill, it is disappointing that this rule also includes these two other provisions--especially the martial law rule.

Let me begin with H.R. 1216. This bill is simple--it's another chance for the Republicans to dismantle the Affordable Care Act. It's one more part of their repeal agenda.

The funny thing is, Mr. Speaker, Republicans continue to push their repeal agenda, but they haven't put any plan forward to replace these new health care provisions that we passed. The truth is that the Republicans are not only trying to repeal the Affordable Care Act, they are also trying to repeal Medicare. This is outrageous. The American people do not want the House Republicans to dismantle Medicare.

The Affordable Care Act, Mr. Speaker, provides dedicated funding for the training of family doctors through graduate medical education programs at teaching health centers. The Republicans, while they claim they support doctors and training programs, don't believe in this dedicated funding. This bill not only rescinds the direct funding for these programs, it reduces the authorization by nearly $50 million.

Now, everyone knows there is a shortage of primary care physicians in this country. Why, then, do Republicans want to undercut efforts to bring physicians into areas of desperate need?

Making these funds discretionary will jeopardize the 11 programs currently underway across the country--including one program in my home State of Massachusetts. Making these funds discretionary does nothing to help our constituents who are struggling to obtain primary care. Making this program discretionary will deter other entities from making business decisions necessary to expand residency training--decisions like securing commitments from key stakeholders to agree to train new or additional residents, applying for accreditation if not already eligible, and hiring new faculty with funding over the next few years.

Finally, claims that this bill saves hundreds of millions of dollars are just not true. Republicans may claim that this bill will cut nearly $200 million from the deficit, but that's only true if Congress provides no funding for this program. CBO--the nonpartisan budget arbiter that Republicans frequently ignore--estimates that $184 million will be appropriated over 5 years, meaning only $11 million will be saved by H.R. 1216. So claims of this incredible fiscal austerity are simply not true.

Now, a second part of this rule is the martial law portion for same- day consideration of the Patriot Act extension. The Senate is currently debating this reauthorization, and the Republicans feel it necessary to once again jam this bill through this House as soon as the Senate is done with it. This is no way to debate legislation dealing with our homeland security and basic civil rights and civil liberties. This is an important issue. Members need time to be able to understand all of the implications of the Patriot Act.

Lastly, Mr. Speaker, let me say just a few words about the fiscal year 2012 National Defense Authorization Act which we will begin general debate on later today.

All Members of this House are strongly committed to protecting our national security--regardless of party, region, or political point of view. It has been the tradition of the House Armed Services Committee, at the staff and Member level, to work in a bipartisan way to carefully craft the annual defense authorizations bill, and I recognize Chairman Buck McKeon and Ranking Member Adam Smith for continuing that collegiality.

But given such a tradition, it comes as a surprise to see so many provisions in H.R. 1540 that attempt to repudiate and attack several of the President's national security policies. From warehousing low-level detainees for an indeterminate amount of time, to delaying the implementation of the repeal of Don't Ask, Don't Tell, to hamstringing the implementation of the bipartisan-supported New START Treaty, to seeking a so-called updated authorization for the use of military force that no longer references the devastating 9/11 attacks against America, but instead gives broad authority to the executive branch to pursue military operations anywhere for any length of time--such changes have all the appearance of a partisan agenda.

This afternoon, the Rules Committee will be reviewing many of the amendments on these and other issues, and I hope that they will be made in order so that a broad range of issues and recommendations might be considered and voted upon by this body.

Now, a number of those amendments will deal with the future of our policy and military operations in Afghanistan.

As most of my colleagues know, I believe that we need to rethink our strategy in Afghanistan. It is bankrupting our Nation. The gentlelady from North Carolina talks about the deficit. I will remind her and others that we are borrowing to pay for the war in Afghanistan. We are borrowing approximately $8.2 billion a month. That's billion with a ``b.''

So if we're going to get serious about deficit reduction, we either need to end these wars--which I think we should do--or if you support them, you ought to pay for them.

This war has already demanded the lives of 1,573 of our service men and women and gravely wounded tens of thousands of our troops. And right now, there is no true end in sight.

The death of Osama bin Laden creates an opportunity for us to reexamine our policy in Afghanistan and ask the President exactly how and when he will bring the last troops home to their families and their communities.

The death of bin Laden provides us with a moment to commend our intelligence and uniformed men and women, and it also allows us to bring fresh eyes to what kind of defense budget and priorities best fit the needs of our Nation and our national security, especially in these difficult economic times.

I hope that the Rules Committee will embrace such a debate, allow a broad range of amendments to be made in order, and support a fresh and critical examination of the policies and priorities put forward in H.R. 1540.

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

I yield myself such time as I may consume.

Mr. Speaker, I feel I need to clarify the record on a couple of things.

My friend from North Carolina said that the Republicans want to protect Medicare. I would suggest that she read the bill that she voted for and other Republicans voted for, the so-called

Ryan budget. The way they protect Medicare is by destroying it. They turn it into a voucher system. And it will mean seniors will pay more and they will get less protection. It is outrageous what they're proposing. And more and more Americans are reading the bill, and they are outraged by what they are seeing.

Democrats, and I hope some thoughtful Republicans, will stand firm and protect Medicare. It is the most important, successful program in our history, along with Social Security. And efforts to dismantle it and to put more burden on our senior citizens for their health care, and basically a major giveaway to the insurance companies, is not protecting Medicare.

The gentlelady talks about the reckless spending in Washington. I will remind all of my colleagues that when Bill Clinton left office, we didn't have a deficit; we were paying down our debt. There was a detailed article in The Washington Post not too long ago explaining how we went from no deficit to now a huge deficit. It includes tax giveaways to the wealthiest people in this country that were not paid for, you know.

I find it somewhat sad that one of the first things that was done in terms of addressing some of our economic concerns was to protect the tax cuts for people like Donald Trump but then to go in and cut emergency fuel assistance for poor people and to go after food and nutrition programs and Pell Grants. That's not the way we should be balancing the budget.

But The Washington Post talks about these tax cuts for the wealthy that were not paid for; on top of that, two wars that were not paid for. Now, I am against these wars; but if you are for them, you ought to pay for them. That's the way we have done it throughout our history. World War II, we paid for it. There was a war tax. We had war bonds. The Vietnam War was paid for in part by eroding Lyndon Johnson's Great Society. It was paid for. But now we have these wars that are not paid for, $8.2 billion a month in Afghanistan alone.

So I hope this is not a partisan agenda when we talk about the war in Afghanistan, and I am not here to put the blame on one party or another. I hope that we can have these amendments on the floor and have some thoughtful discussion about ways we could bring this war to an end. I think Democrats, and I know a lot of Republicans, feel that we should bring this war to an end.

In terms of energy policy, I think people are horrified that we continue to protect taxpayer subsidies to Big Oil companies while they are gouging us at the gas pump. It is unbelievable that we can't have a debate on this floor about taking away these taxpayer subsidies to Big Oil that are making record profits. So I hope that we will talk a little bit more about that at the end of this debate.

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

Mr. Speaker, I yield 3 minutes to the gentleman from Ohio (Mr. Kucinich).

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

The late great Daniel Patrick Moynihan once said, you're entitled to your own opinions, but not your own facts. And the fact is, Mr. Speaker, when this record surplus was turned into a record deficit, I will remind the gentlelady that the Republicans controlled the House, they controlled the Senate, and they controlled the White House. And that is when we passed these tax cuts for the richest people in the world, and they were not paid for. And that is when we embarked on two wars that were not paid for.

It appears that the gentlelady wants to continue these wars. I want to end them. But if you're going to continue them, then pay for them, because it is not fair to the men and women who are sacrificing their lives and the men and women who are in harm's way and their families to just accumulate all this debt and pass it on to them, their children and their grandchildren. If we are going to go to war, we all ought to take some responsibility.

And, finally, on the issue of the taxpayer subsidies for oil companies, we have not had a debate on this House floor or a vote on this House floor on this. I don't care what the Senate did or did not do. I'm not a Member of the United States Senate. I'm a Member of the United States House of Representatives. And under this new and open process that we were promised, by the way, not a single open rule yet-- not a single open rule--but under this new and open process, we can't bring an amendment to the floor to be able to debate this issue.

So I would respectfully suggest that maybe my colleague from North Carolina and the Rules Committee will once in a while vote for an open rule so we can bring some of these things to the floor.

At this time I would like to yield 3 minutes to the gentleman from Colorado (Mr. Polis).

Mr. Speaker, I would like to yield 2 minutes to the gentleman from New York (Mr. Bishop).

May I ask how much time I have remaining, Mr. Speaker.

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

Mr. Speaker, I want to support the efforts of my colleague from New York (Mr. Bishop). And let me just say the American people are sending a clear message to Republicans: Show us the jobs. After 140 days of the new GOP majority, they keep pursuing their agenda that destroys jobs and stalls our economic growth.

This week is no different. And today, Republicans are only making matters worse, voting to kill graduate medical education in qualified teaching health care centers.

The previous question, as Mr. Bishop referred to it, is based on H.R. 964, the Federal Price Gouging Prevention Act. And it takes a stand for working families facing tough times and paying so much more at the pump. During an international oil crisis, as declared by the President, this legislation makes it illegal to sell gasoline at excessive prices and prevents Big Oil from taking advantage of consumers and engaging in price gouging.

The cost of a barrel of oil and a gallon of gas has reached their highest level in years, with no end in sight, and America's middle class is paying the price.

Republicans must join with Democrats to oppose price gouging and to ease the burden on our middle class. We must work together to create jobs, strengthen the middle class, and responsibly reduce the deficit.

To help consumers at the pump and provide some relief to small businesses and families struggling with high gas prices, this legislation expands the authority of the President to release oil from the Strategic Petroleum Reserve to combat market manipulation and bring down the price, and makes it a Federal crime to sell gasoline at excessive prices.

The legislation also protects taxpayers, holds Big Oil accountable, repeals the largest tax breaks for the Big Five Oil companies, and ensures that oil companies pay billions of dollars owed to taxpayers for drilling on public lands. This is part of our multifaceted effort to lower the price of gas now, bring relief to consumers and taxpayers, strengthen our energy security, reduce our dependence on foreign oil, and hold Big Oil accountable.

Republicans' ``drill-only, oil above all'' plan is really a boon for Big Oil and does nothing to reduce the pain at the pump for America's middle class families who are facing these prices each and every day. Republicans are simply returning to the Bush policies for Big Oil-- continuing to purse ``drill-only'' policies with fewer safeguards and no accountability, that has us sending a billion dollars a day overseas for foreign oil.

Mr. Speaker, if we defeat the previous question, I will offer an amendment to the rule to provide that immediately after the House adopts this rule, it will bring up H.R. 964, the Federal Price Gouging Prevention Act introduced by Representative Tim Bishop of New York.

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

Mr. Speaker, I urge my colleagues to vote ``no'' and defeat the previous question so we can debate and pass a bill that actually addresses the price of gas. I have tried, Mr. Speaker, on numerous times in the Rules Committee to bring responsible amendments to the floor that would get at this issue of taxpayer subsidies to Big Oil companies, and every single time my Republicans friends have voted ``no.'' Every time there has been an opportunity to try to address this issue, they have voted ``no.''

I urge my colleagues to vote ``no'' and defeat the previous question, and I urge a ``no'' vote on the rule.

I yield back the balance of my time.

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

Mr. Speaker, I demand a recorded vote.

Mr. Chair, the underlying legislation guts funding for vital teaching health centers across the country. Teaching health centers are residency programs for primary care physicians. They provide community-based training for doctors who will go on to work in rural and our underserved areas.

Mr. Chair, my amendment is very simple. It requires that we find out exactly how many primary care physicians we will lose if Republicans succeed in cutting teaching health centers across the country. My amendment commissions the Government Accountability Office to report on these findings so that the American people can see how drastically these cuts will eliminate jobs and hurt the quality, access, and affordability of primary care health options.

I'm interested to know, Mr. Chair, if some of my Republican colleagues are aware that if H.R. 1216 is adopted, there will be fewer primary care doctors working in their communities. For example, this bill guts funding for 23 physicians at the teaching health center in the heart of Scranton, Pennsylvania. These 23 individuals are being trained to provide basic health care for constituents in the greater Scranton area. If my Republican colleague from the Scranton area joins the Republican leadership in eliminating this program, his community will lose training for 23 new primary care physicians. That's 23 jobs, jobs that they support, and 23 individuals who help serve constituents with their health care needs.

Again, Mr. Chair, my amendment is a matter of effective oversight. It asks that we find out from a nonpartisan source exactly how many primary care physicians we will lose if the Republican leadership moves forward to cut teaching health centers across the country.

Mr. Chair, I have an amendment at the desk.

Mr. Chair, my friends on the other side of the aisle seem steadfast and determined in their attack on access to affordable, quality health care. Couple that with their plan to end Medicare, and our Nation's seniors are put in quite a bind. Meanwhile, they want to place our health in the hands of Wall Street and Big Insurance, not between doctors and their patients. The seniors in my district and across the country know that vouchers will not cover their health care needs. They see the tax breaks for millionaires and billionaires and handouts for Big Oil, and are vehemently opposed to this plan.

Today, we have yet another assault on affordable access to health care. My Republican colleagues have found their next boogeyman: family practice physicians. This is surprising as we have a dire shortage of primary care physicians in our country.

The American Association of Medical Colleges has estimated that an additional 45,000 primary care physicians are required by 2020 just to meet America's health care needs. A few short months ago, both sides of the aisle agreed on the need to build our Nation's primary care workforce. This is a proven way to bend the health care cost curve by decreasing health spending through prevention and early, simple treatment.

Unfortunately, Republicans have since changed their tune. They have declared that the problem is not that we have a shortage of these crucial doctors. Instead, they must believe we have too many primary care physicians, and so we face this call to eliminate training for those on the front lines of the fight for quality care.

The underlying legislation guts funding for vital teaching health centers across our country. Teaching health centers are residency programs for primary care physicians, providing community-based training for doctors who will go on to work in rural and in our underserved areas. From Medicare to high gas prices to tax rates, my friends on the other side have proposed time and time again policies that put middle class Americans on the line and let Wall Street, Big Oil and Big Insurance take over and earn big. The constituents in my home district, in the Capital Region of New York State, need a break. They are looking at the price of gas, at the price of food and at the price of prescription drugs, and are just wondering how they will make it through the month.

Do we need to balance the budget? Yes. Do we need to balance the budget on the backs of hardworking Americans who play by the rules? Absolutely not.

Mr. Chair, my amendment is very simple. It requires that we find out exactly how many primary care physicians we will lose if Republicans succeed in cutting teaching health centers

across the country. My amendment commissions the Government Accountability Office to report on these findings so that the American people can see how drastically these cuts will eliminate jobs and will hurt the quality, access and affordability of primary care health options.

I am interested to know, Mr. Chair, if some of my Republican colleagues are aware that, if H.R. 1216 is adopted, there will be fewer primary care doctors working in their communities. For example, this bill cuts funding for 23 physicians at the teaching health center in the heart of Scranton, Pennsylvania. These 23 individuals are being trained to provide basic health care for constituents in the greater Scranton area.

If my Republican colleague from the Scranton area joins the Republican leadership in eliminating this program, his community will lose training for 23 new primary care physicians. That's 23 jobs, the many jobs they support and 23 individuals who will serve constituents in need.

Mr. Chair, if my colleague from Pennsylvania would like to come to the floor to defend the rights of the teaching health center in Scranton against this shortsighted and unjust attack by the Republican leadership, I would gladly yield him time.

The same challenge is faced by my colleague from the Billings, Montana, area, whose district will lose funding to train seven primary care physicians specifically for the health care needs of rural Montanans. In Idaho, Illinois, Texas, and Washington, it's the same story. All of these communities are seeing good American jobs put at risk--and for what?--to fund handouts to insurance and oil companies? to pay for even more tax breaks to millionaires, billionaires and some of the wealthiest corporations on Earth?

I would gladly yield my Republican colleagues from these districts time to defend their constituents.

Again, Mr. Chair, my amendment is a matter of effective oversight. It asks that we find out from a nonpartisan source exactly how many primary care physicians we will lose if the Republican leadership moves forward to cut teaching health centers across our country.

When it comes to ensuring our constituents have access to basic primary health care, when it comes to protecting Medicare and Social Security for our seniors and to ensuring they have healthy and comfortable retirements, there should be no disagreement.

Please join me in supporting this amendment and in standing with middle class Americans across the country.

With that, I yield back the balance of my time.

Mr. Chairman, I demand a recorded vote.

Madam Chair, I move to strike the last word.

Madam Chair, I rise in opposition to H.R. 1216, the underlying bill. As a resident of upstate New York, where much attention has been given to today's special election for a congressional seat, people are saying loud and clear, Hands off my Medicare.

Republicans are determined again to put us on the road to ruin with their plans to end Medicare. Despite outcries from their constituents, they are pushing forward to end a program that 46 million seniors and disabled individuals depend on for their health care. This gross injustice is made immeasurably more egregious and offensive by the fact that this is being done not to balance the budget, but to expand and permanently guarantee even bigger tax cuts for millionaires and billionaires, and to give new tax breaks to some of the world's most profitable companies, including oil.

I have heard a lot of talk in the last few months about the need to make tough choices these days. The average senior on Medicare earns just over $19,000 a year. About one quarter of Medicare beneficiaries suffer from a cognitive or mental impairment, and most have at least one or more chronic medical conditions. So I ask my Republican colleagues, what exactly is it about stripping these Americans bare of their health and economic security that qualifies as tough? There is nothing tough about stealing from the poor or the weak to give to the rich.

Our seniors, on the other hand, know all about tough choices: Do I buy groceries, or do I buy prescriptions? Do I pay rent, or do I pay medical bills? It hurts, but how much will it cost? These are those tough choices. These are life and death choices. With the passage of Medicare in 1965, we entered into a covenant with each and every American citizen.

The Republican voucher plan ends Medicare. Instead, seniors will be on their own with a measly voucher and forced to buy insurance in the private market, where all decisions will be profit-driven. More profits for insurance companies on the backs of seniors. Sounds like a Republican plan to me. This new voucher program amounts to a ration card. The value of the voucher is not linked to increases in health care costs in the private market, yet the costs of private health insurance have risen over 5,000 percent since the creation of Medicare--5,000 percent.

The analysis of the nonpartisan Congressional Budget Office has estimated that in less than 20 years these vouchers would pay just 32 cents on every dollar that a senior would spend on health care premiums. Now, the Republican leadership has repeatedly stated that this budget gives seniors the same coverage as Members of Congress. Well, as a Member of Congress myself, I know that our health plans pay for about 72 cents on every dollar of health coverage, not 32 cents.

America knows that legislation in Congress carries a statement of priorities and values, not purely dollars and cents. And what sense does it make to cut funding for training primary care physicians who are on the front lines not only of keeping our constituents and communities healthy, but also of lowering health care costs with early, simple treatments?

I urge my colleagues to stand with our seniors and stand up for middle class priorities. Let's defend our middle class. Let's defend our working families. I urge my colleagues to oppose this bill.

Madam Chair, I yield back the balance of my time.