Providing for consideration of the bill (H.R. 5) to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system.

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

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

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

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

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

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

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

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

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

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

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

March 7, 2012.

Dear Member of Congress: The organizations listed below

represent a breadth of entities including all sectors of the

healthcare industry, employers of different sizes and

geographic locations, as well as purchasers of care,

consumers and patients. We all share the conviction that the

Independent Payment Advisory Board (IPAB) will not only

severely limit Medicare beneficiaries' access to care but

also increase healthcare costs that are shifted onto the

private sector. While we all recognize the need for more

sustainable healthcare costs, we do not believe the IPAB is

the way to, or will, accomplish this goal.

As you know, the Patient Protection and Affordable Care Act

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

the President and empowered to make recommendations to cut

spending in Medicare if its spending growth reaches certain

measures. The IPAB will have unprecedented power with little

oversight, even though it has the power to literally change

laws previously enacted by Congress. Further, the law

specifically prohibits administrative or judicial review of

the Secretary's implementation of a recommendation contained

in an IPAB proposal.

We are deeply concerned about the impact the IPAB will have

on patient access to quality healthcare. The bulk of any

recommended spending reductions will almost certainly come in

the form of payment cuts to Medicare providers. This will

affect patient access to care and innovative therapies. In

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

of physicians unable to accept new Medicare patients because

of low reimbursement rates has more than doubled. According

to an American Medical Association survey, current

reimbursement rates have already led 17 percent of all

doctors, including 31 percent of primary care physicians, to

restrict the number of Medicare patients in their practices.

In all likelihood, the IPAB will only exacerbate this

problem.

While we are all supportive of improving the quality of

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

be able to focus on improving healthcare and delivery system

reforms, as some of its proponents have suggested. Requiring

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

period is not conducive to generating savings through long-

term delivery system reforms. According to a recent Kaiser

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

achieve Medicare savings for the implementation year provides

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

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

important for Medicare and the underlying growth in health

care costs, including delivery system reforms that MedPAC and

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

which generally require several years to achieve savings. If

these delivery system reforms are not `scoreable' for the

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

consider more predictable, short-term scoreable savings, such

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

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

Board is likely to focus its recommendations on changes to

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

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

a severe, negative impact on Medicare beneficiaries.

Last, we believe that the IPAB sets a dangerous precedent

for overriding the normal legislative process. Congress is a

representative body that has a duty to legislate on issues of

public policy. Abdicating this responsibility to an unelected

and unaccountable board removes our elected officials from

the decision-making process for a program that millions of

our nation's seniors and disabled individuals rely upon,

endangering the important dialogue that takes place between

elected officials and their constituents.

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

savings in Medicare and strongly urge Congress to eliminate

this provision.

Sincerely,

Abigail Alliance, Action CF AdvaMed, Advocates for

Responsible Care, AIDS Delaware, AIDS Drug Assistance

Programs Advocacy Association, AIDS Housing Association of

Tacoma, AIDS Institute, Alabama Orthopaedic Society, Alabama

Podiatric Medical Association, Alaska State Chamber of

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

Alliance for Aging Research, Alliance of Specialty Medicine,

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

Center, Alzheimer's Arkansas, American Academy of Facial

Plastic & Reconstructive Surgery, American Academy of

Neurology.

American Academy of Otolaryngology--Head and Neck Surgery,

American Academy of Physical Medicine and Rehabilitation,

American Association for the Study of Liver Diseases,

American Association of Clinical Endocrinologists, American

Association of Clinical Urologists, American Association for

Homecare, American Association for Marriage and Family

Therapy, American Association of Neurological Surgeons,

American Association of Orthopaedic Executives, American

Association of Orthopaedic Surgeons, American Autoimmune

Related Diseases Association, American College of Emergency

Physicians, American College of Emergency Physicians--Indiana

Chapter, American College of Mohs Surgery, American College

of Osteopathic Surgeons, American College of

Radiology, American College of Surgeons--Missouri Chapter,

American Congress of Obstetricians and Gynecologists,

American Gastroenterological Association, American Liver

Foundation--Allegheny Division.

American Osteopathic Academy of Orthopedics, American

Physical Therapy Association, American Podiatric Medical

Association, American Society of Anesthesiologists, American

Society of Breast Surgeons, American Society of Cataract and

Refractive Surgery, American Society of General Surgeons,

American Society of Plastic Surgeons, American Society of

Radiation Oncology, American Urological Association,

Americans for Prosperity, Amigos por la Salud, Arizona

BioIndustry Association, Arizona Medical Association, Arizona

Podiatric Medical Association, Arizona Urological Society,

Arkansas Medical Society, Arkansas Orthopaedic Society,

Arkansas Podiatric Medical Association, Associated Industries

of Florida.

Association for Behavioral Healthcare, Association of

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

California Chapter, Asthma & Allergy Foundation of America--

New England Chapter, Bay Bio, BEACON (Biomedical Engineering

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

Biotechnology Industry Organization (BIO), Bismarck-Mandan

Chamber of Commerce, California Healthcare Institute,

California Hispanic Chambers of Commerce, California Medical

Association, California Orthopaedic Association, California

Podiatric Medical Association, California Rheumatology

Alliance, California Urological Association, Capital Region

Action Against Breast Cancer!, Center of the American

Experiment.

Children's Rare Disease Network, Coalition for Affordable

Health Coverage, Coalition of State Rheumatology, Council of

University Chairs of Obstetrics & Gynecology Organizations,

Colorado Academy of Family Physicians, Colorado BioScience

Association, Colorado Cross-Disability Association, Colorado

Gerontological Society, Colorado Podiatric Medical

Association, Colorado Retail Council, Colorado Springs Health

Partners, Community Health Charities of Florida, Community

Health Charities of Nebraska, Congress of Neurological

Surgeons, Community Oncology Alliance, Connecticut

Orthopaedic Society, Connecticut Podiatric Medical

Association, Connecticut State Urology Society, Delaware

Academy of Medicine, Delaware Ecumenical Council on Children

and Families.

Delaware HIV Consortium, Delaware Podiatric Medical

Association, Delaware State Orthopaedic Society, Docs 4

Patient Care, Easter Seals, Easter Seals Crossroads, Easter

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

Easter Seals of Massachusetts, Easter Seals of New Jersey,

Easter Seals of Southeastern PA, Easter Seals of South

Florida, Easter Seals UCP North Carolina, Elder Care Advocacy

of Florida, Florida Chamber of Commerce, Florida Medical

Association, Florida Podiatric Medical Association, Florida

Society of Neurology, Florida Society of Rheumatology.

Florida Society of Thoracic & Cardiovascular Surgeons,

Florida State Hispanic Chamber of Commerce, Florida

Transplant Survivor's Coalition, Florida Urological Society,

Georgia Association for Home Health Agencies, Georgia Bio,

Georgia Orthopaedic Society, Georgia Podiatric Medical

Association, Global Genes, Global Healthy Living Foundation,

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

Healthcare Institute of New Jersey, Healthcare Leadership

Council, HealthHIV, Hemophilia Foundation of Maryland, Heart

Rhythm Society,

Hoosier Owners and Providers for the Elderly, Idaho Medical

Association, Idaho Podiatric Medical Association.

Illinois Association of Orthopaedic Surgeons, Illinois

Biotechnology Industry, Organization--iBIO',

Illinois Chamber of Commerce, Indiana Association of Cities

and Towns, Indiana Health Care Association, Indiana Health

Industry Forum, Indiana Medical Device Manufacturers Council,

Inc., Indiana Neurological Society, Indiana Podiatric Medical

Association, Indiana State Medical Association,

InterAmerican College of Physicians & Surgeons,

International Franchise Association, International

Institute for Human Empowerment, International Society for

the Advancement of Spine Surgery, Iowa Orthopaedic

Society, Iowa Podiatric Medical Association, Kansas

Medical Society, Kansas Podiatric Medical Association,

Kansas Urological Association.

Kentucky BioAlliance, Kentucky Medical Association,

Kentucky Podiatric Medical Association, Kidney Cancer

Association of Illinois, Large Urology Group Practice

Association, Latino Diabetes Association, Licensed

Professional Counselors Association of Georgia, Louisiana

State Medical Society, Lupus Alliance of America--Hudson

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

Island Affiliate, Lupus Alliance of America--Southern Tier

Affiliate, Lupus Alliance of America--Upstate New York

Affiliate, Lupus Foundation of Arkansas, Lupus Foundation of

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

Foundation of Mid and Northern New York, Lupus Foundation of

the Genesee Valley, Lupus Foundation of Pennsylvania, Mabel

Wadsworth Women's Health Center, Maine Health Care

Association.

Maine Osteopathic Association, Maine Podiatric Medical

Association, Maine State Council of Vietnam Veterans of

America, Maryland Orthopaedic Association, Maryland State

Medical Society, Massachusetts Association for Behavioral

Health Systems, Massachusetts Association for Mental Health,

Massachusetts Biomedical Initiatives, Massachusetts Medical

Device Industry Council, Massachusetts Orthopaedic

Association, Massachusetts Podiatric Medical Society, Medical

Association of Georgia, Medical Association of the State of

Alabama, Medical Society of Delaware, Medical Society of the

District of Columbia, Medical Society of the State of New

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

Mental Health America of Indiana, Mental Health America of

Greater Houston.

MichBio, Michigan Chamber of Commerce, Michigan College of

Emergency Physicians, Michigan Podiatric Medical Association,

Michigan Orthopaedic Society, Michigan Society of

Anesthesiologists, Minnesota Podiatric Medical Association,

Minnesota State Grange, Mississippi Arthritis and Rheumatism

Society, Mississippi Orthopaedic Society, Mississippi

Podiatric Medical Association, Missouri State Medical

Association, Missouri Urological Association, Montana

Orthopaedic Society, National Alliance on Mental Illness,

National Alliance on Mental Illness Colorado, National

Alliance on Mental Illness Florida, National Alliance on

Mental Illness Georgia, National Alliance on Mental Illness

Indiana, National Alliance on Mental Illness Maine.

National Alliance on Mental Illness Michigan, National

Alliance on Mental Illness NC, National Alliance on Mental

Illness Texas, National Association for Home Care & Hospice,

National Association for Home Care & Hospice--Indiana

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

Chapter, National Association for Uniformed Services,

National Association of Manufacturers, National Association

of Nutrition and Aging Services Programs, National

Association of People with AIDS, National Association of

Social Workers NC, National Association of Spine Specialists,

National Council of Negro Women, National Council of Negro

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

Community Behavioral Healthcare, National Health Foundation,

National Hemophilia Foundation--Delaware Valley Chapter,

National Kidney Foundation--Ohio Chapter, National Medical

Association, National Minority Quality Forum.

National Retail Federation, NCBIO, Nebraska Academy of

Physician Assistants, Nebraska Medical Association, Nebraska

Orthopaedic Society, Nebraska Urological Association,

Neurofibromatosis Mid-Atlantic, Nevada Orthopaedic Society,

Nevada Podiatric Medical Association, Nevada State Medical

Association, New Hampshire State Grange, New Horizons Home

Health Services, New Jersey Academy of Ophthalmology, New

Jersey Mayors Committee of Life Science, New Jersey Podiatric

Medical Society, New Mexico Podiatric Medical Association,

New York Podiatric Medical Association, New York State

Rheumatologists Society, New York State Urological

Society, North Carolina Association on Aging.

North Carolina Psychological Association, North Carolina

Rheumatology Association, North Carolina Urological

Association, North Dakota Chamber of Commerce, North Dakota

Medical Association, North Dakota Policy Council, Northwest

Urological Society, Ohio Association of Ambulatory Surgery

Centers, Ohio Association of County Behavioral Health

Authorities, Ohio Association of Medical Equipment Services,

Ohio Hospital Association, Ohio Orthopaedic Society, Ohio

State Grange, Ohio State Medical Association, Ohio Urological

Society, Ohio Veterans United, Oklahoma Podiatric Medical

Association, Oklahoma State Medical Association, Oklahoma

State Orthopaedic Society, Oklahoma State Urologic

Association.

Old North State Medical Society, Oregon Medical

Association, Oregon Podiatric Medical Association, Partners

in Care Foundation, Partnership for Drug Free North Carolina,

Pennsylvania BIO, Pennsylvania Chamber of Business &

Industry, Pennsylvania Medical Society, Pennsylvania

Orthopaedic Society, Personal Coaching & Psychotherapy for

Women, PhRMA, Premier healthcare alliance, RARE Project,

RetireSafe, Rhode Island Medical Society, Rio Grande

Foundation, New Mexico, Rocky Mountain Stroke Center, Rural

Health IT, Sanfilippo Foundation for Children, Society for

Cardiovascular Angiography and Interventions.

Society for Vascular Surgery, Society of Gynecologic

Oncology, Society of Urologic Oncology, South Carolina BIO,

South Carolina HIV/AIDS Care Crisis Task Force, South

Carolina Medical Association, South Carolina Orthopaedic

Association, South Carolina Podiatric Medical Association,

South Carolina Urological Association, South Dakota Podiatric

Medical Association, South Dakota State Orthopaedic Society,

South Jersey Geriatric Care PC, South Jersey Senior

Networking Group, Southeastern Medical Device Association

(SEMDA), Southwest Michigan Pharmacist Association, Stockton

Center on Successful Aging, Syndicus Scientific Services,

Team Sanfilippo Foundation, Tennessee Medical Association,

Tennessee Orthopaedic Society.

Tennessee Podiatric Medical Association, Texas Healthcare &

Bioscience Institute, Texas Podiatric Medical Association,

Texas Urological Society, The Center for Health Care

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

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

Society of New Jersey, Utah Medical Association, Utah

Podiatric Medical Association, Utah State Orthopaedic

Society, Vascular Society of New Jersey, Vermont Medical

Society, Vermont Podiatric Medical Association, Veterans

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

Virginia Biotechnology Association.

Virginia Podiatric Medical Association, Visiting Nurse

Association of Ohio, Washington Biotechnology & Biomedical

Association, Washington Free Clinic Association, Washington

Osteopathic Medical Association, Washington State Podiatric

Medical Association, Washington Rheumatology Association,

Washington State Medical Association, Washington State

Urology Society, WERAK Foundation, West Virginia Academy of

Otolaryngology, West Virginia Chapter of the American College

of Cardiology, West Virginia Manufacturer's Association, West

Virginia Orthopaedic Society, West Virginia State Medical

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

Wisconsin Hospital Association, Wisconsin Urological Society,

Wyoming State Grange, Women Against Prostate Cancer.

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

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

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

I yield myself 15 seconds.

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

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

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

I yield myself 30 seconds.

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

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

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

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

Certainly you would reclaim your time.

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

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

I yield the gentleman an additional 30 seconds.

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

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

I yield the gentleman an additional 15 seconds.

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

Madam Speaker, by direction of the Committee on Rules, I call up House Resolution 591 and ask for its immediate consideration.

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

General Leave

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

Madam Speaker, I rise today in support of this rule, House Resolution 591.

H. Res. 591 provides a structured rule so that the House may consider H.R. 5, the Help Efficient, Accessible, Low-cost, Timely Healthcare Act of 2012. The rule provides for 6 hours of debate on this vital issue.

In my opinion, the HEALTH Act is one of the most imperative pieces of legislation to come to the floor of the House in the 112th Congress thus far. The bill repeals a particularly egregious part of the government takeover of health care: the Independent Payment Advisory Board, or IPAB.

In case you're not aware, IPAB is the 15-member panel created by ObamaCare to rein in Medicare costs. IPAB is made up of 15 unelected bureaucrats. The majority are not doctors, and their decisions will have the force of law and will go into effect automatically without the consent of Congress. We'll get back to IPAB in a moment.

H.R. 5 also implements long-needed medical malpractice tort reform. I hear all the time that we need to bring down the cost of health care. My colleagues on the other side of the aisle claim that the government takeover of health care would do just that, reduce the cost of health care.

In fact, President Obama claimed it would lower premiums by $2,500 per family per year. We know that's just not the case. Since inauguration day in 2009, premiums have risen by $2,213, almost the same amount the President promised he was going to save us. The annual Kaiser Foundation survey of employer-provided insurance found that average family premiums totaled $12,860 in 2008 and are now $15,073 in 2011. Moreover, the CBO, the Congressional Budget Office, projects the law's new benefit mandates will force premiums to rise on top of that $15,000 by $2,100 per year per family.

Malpractice reform, on the other hand, will most definitely reduce the cost of health care. We've seen what defensive medicine is: CAT scans ordered, antibiotics prescribed, blood tests conducted--not because the doctor thought they were necessary, but because he or she was scared that if they didn't order them they would be sued for not prescribing them.

A Department of Health and Human Services study said that defensive medicine costs between $70 billion to $126 billion a year. That's billions. The CBO estimate takes a little more moderate stance, putting that number around $54 billion. Let me tell you, $54 billion, $70 billion, $126 billion, that's a lot of money in anybody's terms.

I've heard from a lot of folks they are opposing the legislation because it defies States' rights. I have to say I'm particularly surprised to hear so many of my colleagues on the other side making this argument. I'm happy to see they've come to recognize the importance of States' rights and of State sovereignty. I hope that means that we can count on them for their support and efforts in moving forward to take Federal power away from Washington, D.C., and return that power back to the States, where it belongs and where our Founding Fathers envisioned it to be.

I want to take a moment to make it clear to my colleagues on both sides of the aisle why this bill, H.R. 5, does not trample on the rights of our States.

In the modern era, Congress has enacted many Federal tort reform statutes to supersede contrary State laws, including recent Federal tort reform protecting the vital domestic firearms industry, and judicial precedents leave little doubt as to their constitutionality. Even President Reagan, who was an unabashed champion for the States, established a special task force to study the need for tort reform, which concluded that the Federal Government should address tort reform across the board.

I fear that the folks who are claiming the 10th Amendment and States' rights aren't looking at the entirety of H.R. 5. They aren't looking at all of the provisions that make it clear that the caps created in this bill only apply to States that don't already have their own caps.

These provisions--``flexi-cap'' they are called--recognize that any State amount on caps takes precedence to this piece of legislation. That means if a State has a billion-dollar cap, good for them, let them keep it. It also means that if a State has a $100,000 cap, they can keep it, too. If a State decides to pass a law and establish a cap on their own to change their existing cap, they should go ahead and do it because H.R. 5 isn't going to do anything to stop them from doing that.

H.R. 5 clearly ensures that it is a State's right to set its caps where it wants them. I understand that trial lawyers won't like the Federal limit. Luckily, I really worry about the American people as a whole, not just what trial lawyers have to say.

I know this may be speculation, but I think that special interest groups and, perhaps, some of the new converts to the 10th Amendment are hiding behind the States' rights argument because, in fact, they just don't want to see their own profits go down. But I fear that the States' rights discussion is a red herring that only gets us off the most important issue, the issue that I started off with, the Independent Payment Advisory Board. Plain and simple, IPAB is going to cut the health care that our Nation's seniors can receive.

This Medicare-rationing board, which is what this is, will decide the value of medical services and impose price controls that will slash senior access to doctors and other health care providers. We see this happening already.

The Centers for Medicare & Medicaid Services actuary has confirmed that large reductions in Medicare payment rates to physicians would likely have serious implications for beneficiary access to care, utilization, intensity, and the quality of that care. As Donald Berwick, President Obama's appointee as the Medicare administrator, said:

The decision is not whether or not we will ration care. The

decision is whether we will ration with our eyes open.

H.R. 5 takes that choice away from Administrator Berwick, from IPAB, and from President Obama. H.R. 5 sets forth a new way forward, a way that says we don't need Washington bureaucrats, who haven't even practiced medicine, telling us what's best for us.

We need to sit down with our doctors and come up with individual treatment

plans, a way that actually does something about health care costs by removing frivolous lawsuits from the equation, a way forward that means States' rights are still protected while also protecting seniors' rights to the best health care options available.

Madam Speaker, I support this rule, and I support the underlying legislation, and I encourage all of my colleagues to do the same.

With that, I reserve the balance of my time.

Madam Speaker, I yield 3 minutes to my fellow member of the Rules Committee, a freshman, Rob Woodall from Georgia.

Madam Speaker, I love the hyperbole. I love my friend from Florida's passionate discourse earlier in this conversation. But he was right. You can't have it both ways.

Here's the problem. In their idea of having it both ways, they talk about medical malpractice as if, if we do nothing, things get better. If we ignore tort reform, things get better. If we ignore tort reform, costs of health care will stay the same. Well, in fact, it hasn't. It continues to rise.

We talk about higher health care costs, but when we talk about that and we talk about IPAB in particular, 15--15--unelected bureaucrats. The maximum number that can be on that panel is seven physicians-- seven--so they're outvoted already. They're outvoted 8 7. No matter what they think is the proper care for a patient, they're going to be overridden by eight other bureaucrats that have nothing to do with providing health care to our seniors--not a thing.

It's all going to be about costs. And they're right: that's how you're going to contain costs, by removing the options for seniors to get the medical care that they deserve and that they need.

This independent panel is a rationing board. It's going to ration health care out because that's the only way that panel can save money for the Affordable Care Act. It was designed that way. It was designed to keep us--the American people that are going to use that service, that medical care--from getting it because physicians, when they get their payments cut, will no longer offer service. So where are we supposed to go? That is rationing. That's taking away service from people that need it the most, from those seniors that have paid into this system for their lifetimes and who are now depending on it to be there when they medically need it the most.

This is about the seniors that are in my district. I have 250,000 seniors, a quarter of a million, that rely upon Medicare. And if we're going to start rationing care to them, I think it's immoral, it's unethical, and it's not the way we should be doing it. We should be doing it by the free market. We should be talking about tort reform. Everybody agrees we need tort reform. Even the gentleman from Florida talked about the high cost of medical malpractice insurance. Well, where does that come from? It doesn't just spring up out of the Earth. It comes up because of a reason: because of the increased cost to provide medical malpractice. And, particularly for doctors, where it drives up the cost of medical care is that defensive medical care. That's what's driving up the cost along with the premiums that they have to pay because of the lack of tort reform.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I have to agree with my good friend from Florida on one issue, and that's in regard to rationing. You're right, it's not in the act. But if it walks like a duck, quacks like a duck, then it's a duck, because this board, this unelected board, is going to make decisions that Congress can't even touch. This board is going to say, this is the amount of money we will pay for this procedure. It doesn't matter if that's what the procedure costs. It doesn't matter that this doesn't cover the cost of the physician. It doesn't matter that what's going to happen is our physicians are going to refuse to see those patients.

Madam Speaker, that is rationing. Call it what you want. That is rationing when you have an independent board that can make decisions in regard to the cost of services that you're going to make or decisions for you to have services by a particular doctor. We see it already today. In my physician's office it already says, ``We do not take new Medicare patients.''

It's going to get worse. And this board, while it may not call it ``rationing''--I give them great credit for not putting that in the terminology of the Affordable Care Act--it is rationing no matter what you call it.

I reserve the balance of my time.

If you look at what the Ryan plan said, it also talks about what we currently have today and that, if you want to keep what you have today in the way of Medicare, you keep it. But if you want to go out and buy your own insurance through a select group, you can do it, just as you can today, in regards to Medicare Advantage, but that's a choice that I can make.

I thank you for giving me the time.

Madam Speaker, may I inquire of my good friend from Florida how many more speakers he may have.

I continue to reserve the balance of my time.

Madam Speaker, I'm a little confused because I thought we were talking about other issues than what the gentleman was just speaking to, particularly as relates to IPAB and about tort reform.

I'll be happy to reserve the balance of my time.

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

Madam Speaker, in closing, I appreciate my good friend's confession about being a trial lawyer. I'm not. I'm not an attorney. So what I'm worried about is not how attorneys enrich themselves; I'm worried about the people that I represent, the 250,000-plus that are on Medicare. I'm concerned about them.

You hear from the other side, well, don't worry about it. It could be 5, 10 years from now. Well, you know what? I'm concerned now because why would you have something put in place that's going to ration care to our seniors when they need it the most? That's when they need it the most. We should be advocating for them, not for trial lawyers. We should be here talking about tort reform to lower the cost. If you look at what California did, they're a model. They set up a model program. Their liability insurance for doctors is lower than the average across the board in the United States. This act, the HEALTH Act, is modeled after that.

In regards to the noneconomic damages, limits on contingency fees for lawyers, big one there; about fair share, about proportional, whoever's at fault. It's a proportion of that reference to how the claim gets paid out. And I heard this talked about before: But will the health care act work to reduce health care costs and lower the deficit? According to the CBO, it will. It will be an average of 25 to 30 percent below what it would be under current law, which is IPAB today, 25 to 30 percent less than what the current law, IPAB, calls for.

Is this important? I think the relationship between a patient and a doctor should be between a patient and a doctor and not have a middleman, called the United States Government, stepping in between you to say, ``You know what? We don't think that that service deserves a certain level of payment,'' and by reducing that payment we know that that service is not going to be provided. I truly don't believe that that's where we should be as a government, and I certainly don't believe that we should be in between the patients and their physicians.

I also worry about--and I hear this from docs all the time back in my district--Rich, you know what's going to happen? We're just going to close our doors. Those that are entering the profession, there's less and less because they're concerned about how they're going to make a living, how they're going to pay back those student loans that they have, because they really want to pay it back. They want to do the right thing. But how are they going to do that if they can't open a practice and if they can't take Medicare patients because this board makes a decision to lower the cost of reimbursement?

We've seen it already. Every time we do a doc fix, we have more and more doctors that are in trouble because of the fact they don't know what tomorrow's going to bring, and I don't want our seniors to worry about what tomorrow is going to bring. I don't want to balance the budget on the back of our seniors. That's not where we need to be.

As we move along here, the reason I stand here today is that I support and I will defend our seniors, which is why I support H.R. 5, because it's common sense.

Like I said, I'm not an attorney. I'm not a lawyer, so I have but one constituency that I worry about at this point on this particular issue, and it is this issue. You put all kinds of other stuff out there about transportation and all these things, but this is the pressing issue today in front of us. The issue is about tort reform. The issue is about IPAB and repealing IPAB so our seniors can have a direct relationship with a physician of their choice, and that's the important part.

The material previously referred to by Mr. Hastings of Florida is as follows:

An Amendment to H. Res. 591 Offered by Mr. Hastings of Florida

At the end of the resolution, add the following new

sections:

Sec. 2. 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 a bill

consisting of the text of the bill (H.R. 14) to reauthorize

Federal-aid highway and highway safety construction programs,

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 Transportation and Infrastructure. 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. 3. Clause 1(c) of rule XIX shall not apply to the

consideration of the bill specified in section 2 of this

resolution.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Chairman, I yield myself 1 minute.

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

The appointed membership of the Board shall include

physicians and other health professionals, experts in the

area of pharmaco-economics or prescription drug benefit

programs, employers, third-party payers, individuals skilled

in the conduct and interpretation of biomedical, health

services.

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

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

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

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

Mr. Chairman, I yield myself 1 minute.

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

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

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

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

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

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

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

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

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

Mr. Chairman, I yield myself 1 minute.

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

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

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

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

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

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

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

I yield the gentleman an additional minute.

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

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

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

I yield the gentleman 1 additional minute.

Will the gentleman yield?

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

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

I thank the gentleman for yielding.

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

I will reserve the balance of my time.

I continue to reserve the balance of my time.

I yield myself such time as I may consume.

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

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

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

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

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

I yield myself such time as I may consume.

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

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

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

We have one.

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

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

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

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

I yield the gentleman another 30 seconds.

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

I thank the gentleman for yielding to me.

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

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

I rise in opposition to H.R. 5. Not only does this bill overlook the rights of injured patients, but it's also an attempt by the House Republican leadership to dismantle the Affordable Care Act.

I would remind my friend from Florida that there is no example that allows for any of us to have it both ways. This matter violates the Constitution and, clearly, not just for those who argue the 10th Amendment from a conservative or a liberal perspective. It is all of us that feel very strongly that this measure usurps the power of States.

I'm fond of saying what Randy Barnett, constitutional law professor at Georgetown, said, that people seem to be fair-weather federalists, and they abandon federalism whenever it is inconvenient to someone's policy preferences.

H.R. 5 combines two completely unrelated measures. The first one is the reform of our Nation's medical malpractice system. The second one is the repeal of the Independent Payment Advisory Board, which was established by the Affordable Care Act. Please don't get me wrong; I'm fully aware of the challenges inherent to our medical liability system. The excessive cost of medical malpractice insurance faced by physicians seriously impairs our Nation's health care system by encouraging the practice of defensive medicine. This contributes to higher health care costs for both doctors and patients as well as diminished access to care for consumers.

But while I agree that our medical liability system needs to be changed, I do not believe that it should be at the expense of the fundamental rights of patients, including their ability to seek compensation for wrongful injuries. Indeed, this bill imposes an arbitrary and unfair cap on noneconomic damages that injured patients can receive. Such limitations will extinguish our rights and have devastating consequences for individuals harmed by physicians and medical products.

In addition, this bill seriously encroaches on the 10th Amendment of the Constitution by preempting State laws. And I'm not buying the confusion offered in the Rules Committee yesterday nor by my good friend from Florida. I know preemption when I see it. I know the 10th Amendment, and I know that people have stood for the 10th Amendment. I need not remind my colleagues that countless Republicans have made statements regarding this particular matter not fitting within the framework of the 10th Amendment's commerce provision.

My Republican colleagues like to talk about frivolous lawsuits and unreasonably large jury awards. But I asked the question yesterday of the maker of this particular provision, what is his leg worth? It's easy for us here inside the beltway, and it's easy for us on the Republican or Democratic side, liberal or conservative, to be about the business of talking about somebody's harm. Then what happens is, all of the lawyers that are the bad people of the world, everybody wants the best lawyer when it is them and their problem that is a problem.

I asked the maker of the bill, how much is his leg worth? When you cut off the wrong leg, who can stand among us and say that $250,000 is enough? So where did that cap come from? It came from a 1978 provision, $250,000. This is 2011, moving fast with costs rising.

I ask anybody here or that is within the range of this particular measure at this time, please tell me, when did your health care insurance costs go down? I don't know of any example. I have been paying health care insurance for 49 years, and it's gone up repeatedly during that period of time. And I don't care whether there was a Republican President or a Democratic President, health care costs went up, and I don't think that this little measure here is going to bring it down.

What do you think about the family in Chicago whose perfectly healthy baby was born lifeless because the hospital team failed to provide him with proper oxygenation during labor and to perform an emergency cesarean section on the mother? The boy is now 5 years old, suffers from permanent neurological damage, and is totally dependent on the care of his parents for all his daily activities. You ask his parents if $250,000 is enough for a lifetime of care. Oh, no.

Then you say, well, thrust it on the States. Let Medicaid take care of it. And then what you do under the Ryan budget, my good friend, is you say block-grant Medicaid. I saw that movie in Florida when they block-granted Medicaid, and it was used for everything else other than for poor people. Something is wrong with that movie.

What about the judge in Palm Beach County who had a surgical sponge left in his stomach after having abdominal surgery and had to wait 5 months to have it removed? By then, the pus and bile-stained mass measured more than a foot long and a foot wide, and the rotted part of his intestine had to be removed. Ask him if a lawsuit was frivolous.

Each case and each injury is different. It is not the role of Congress to decide the fate of these individuals and families devastated by malpractice by establishing arbitrary limits on the financial compensation that they are entitled to.

As you all know, the medical malpractice portion of this bill is actually a pay-for, meant to offset the repeal of the Independent Payment Advisory Board, IPAB. IPAB is a board of 15 physicians and experts established by the Affordable Care Act to find ways to control health care costs associated with Medicare.

Under the act, IPAB will make recommendations to slow the growth rate in Medicare spending if spending exceeds a certain target rate. The Congressional Budget Office estimates that the repeal of IPAB would increase direct spending by $3.1 billion over 10 years--$3.1 billion. Now is not the time to repeal measures that can save our Nation money and reduce our deficit without offering any substitute, and that's the take-away from this.

My friends say don't do IPAB; and I say to my friends, well, what do you do? And you do nothing. That's what you do, and that's what you've been doing here in the Congress since we came here. We have given ``do- nothing Congress'' a new meaning. Rather than dealing with jobs, the things that people are completely interested in, rather than passing the infrastructure measure that the Senate has passed that will deal immediately with jobs in America, we are here passing a measure--and it will pass the floor of the House of Representatives--that will go to the Senate and go nowhere. So then what did we do? We did nothing.

The Congressional Budget Office also estimates that, thanks to the cost-saving mechanisms in place in the Affordable Care Act, IPAB will not likely be required to act for the next 10 years.

I heard my colleague, just a minute ago, say that health care costs have gone up since President Obama has been in office. My mom is fond of saying that if we're going to keep pointing back to the other President--if Obama says Bush did it, and Bush says that Clinton did it, and then Clinton said that Bush did it, and Bush said that Nixon did it, and Nixon said that Carter did it--then we could just point back to George Washington and say George Washington did it then and get it all over with rather than continuing this charade before the people, making them think that somehow or another we have the solution here.

Health care costs have gone up, and they're going to continue to go up until we as men and women in the House of Representatives and in the United States Senate and as the American people sit down and decide that this is a solvable problem which will allow us to address those things that are vital in this country.

The bill is a complete waste of time. It does nothing in addition to going nowhere. It does nothing to help the

American people. It contains nothing to improve the affordability and accessibility of health care. And repealing IPAB, if you want to talk about frivolous, that's what frivolous is. Let us give the American people what they really need right now--and that's jobs. How many times do we have to say that down here for people to finally get it?

Frankly, I'm appalled by the hypocrisy of my Republican colleagues who keep stating that Federal spending needs to be kept under control. But at the first opportunity they wind up rejecting one of the most serious tools in place to actually tackle Medicare spending and find ways to make care more affordable.

What are the Republicans offering to replace IPAB? Nothing. Since the beginning of the 112th Congress, the Republican majority has sought to repeal as many provisions of the Affordable Care Act as possible without providing any replacement and absolutely no long-term solution. If we do nothing, Medicare costs will continue to increase, thereby increasing the burden on millions of seniors, disabled individuals, and their families all across this country.

What is the Republican plan? What is the plan? It is to replace Medicare with the new Ryan budget introduced yesterday. It is to replace it with some kind of premium that is nothing but a voucher system that would certainly result in increased costs for seniors and reduced benefits.

The truth is that the Republicans have no plan to reduce Medicare, and I defy them to present it. If you look at the budget that was released yesterday, it's all filled with blank spaces--and I'll fill in the line--nothing, nothing, nothing. So, instead of just repealing IPAB, let us improve it, reform it or replace it. By doing nothing, it's surely not going to fix the problem.

I reserve the balance of my time.

Madam Speaker, my friend from Georgia--and he is my friend--pointed out that his amendment was made in order yesterday. I might add, in keeping with the notion if you can't have it both ways, he would strike all the findings. And it seems to me that that's admitting justification for the authority to pass Federal tort reform. But it directly contradicts the same constitutional arguments they will be making next week before the United States Supreme Court in their effort to repeal the Patient Protection and Affordable Care Act, a bill which many of the same conservative lawmakers argue that Congress did not have the constitutional authority to pass.

I am very pleased to yield 3 minutes to my very good friend from New Jersey, a member of the Budget Committee, the distinguished gentleman (Mr. Andrews).

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

I yield myself such time as I may consume, and I will be very brief before yielding to my friend from the Rules Committee.

My friend from Florida says that he appreciates the hyperbole. I hyperbole on occasion when I find that my friends who are taking positions that are going to hurt people require everything from hyperbole to passion to try to get the American people to readily understand. And to demonstrate what I'm talking about, my friend just stood and said that the IPAB board will be rationing. The statute, the provision giving rise to it, if it ever comes into existence in the future, specifically says that they cannot ration. I don't know whether my friend read that provision or not.

But I am pleased to yield 1 minute to my friend on the Rules Committee, the gentleman from Colorado (Mr. Polis).

I yield myself such time as I may consume.

I would be happy to yield to my friend just for a moment. So then what you're saying is, the IPAB board, which may bring down costs--and I might add you just said that Congress could not touch it, quoting you--that's not true. Congress could change it as long as it stays within the prescribed limits, and that is simply what the law, itself, says.

But what is the Republican plan? As I understand it from Mr. Ryan's budget as offered yesterday, it would be a premium system for Medicare. Now you've just said that rationing by any other name or that you know it when it's a duck, and all of that kind of stuff. Well, a voucher by any other name is still a voucher, and you're going to tell me that that's a good system?

I yield to my friend.

I reclaim my time only to say that you had it right, ``select.'' For example, our Governor in the State of Florida had one of those select provisions, and he's one of those people that wants us to turn everything over.

I happened to have had the good fortune yesterday of having the chairman

of Blue Cross Blue Shield visit me, who thinks that this particular measure is something that would be helpful in his industry, but that's something for another day.

Madam Speaker, if we defeat the previous question, I'm going to offer an amendment to the rule to provide that immediately after the House adopts this rule that it bring up H.R. 14, the House companion to the bipartisan Senate transportation bill.

I am pleased now to yield 3 minutes to my good friend, the distinguished gentleman from New York (Mr. Bishop).

I yield the gentleman 1 additional minute.

I appreciate the gentleman for asking.

Madam Speaker, would you advise both of us how much time each has.

I have more speakers than I have time; but I know that during that period of time, I'm going to have at least two more speakers and possibly three.

Madam Speaker, I am very pleased to yield 2 minutes to my good friend, the distinguished gentleman from Oregon (Mr. DeFazio).

Madam Speaker, I am very pleased to yield 1 minute to my good friend, the distinguished gentlewoman from California (Ms. Richardson).

I yield the gentlelady an additional 30 seconds.

Madam Speaker, would you tell me just how much time I do have.

Madam Speaker, I thank my friend for the debate and the time that he's allowed us. I thank all of our colleagues who came here.

This H.R. 5 is going to be devastating to medical malpractice victims. Patients shouldn't have to pay the price for excessive malpractice insurance.

If we want to reform the medical liability system, let us start with addressing insurance costs and physicians' premiums. Let us start with finding strategies to reduce and prevent mistakes and crack down on repeat offenders. Today, 5 percent of all doctors are responsible for 54 percent of malpractice claims paid.

Let's not start with penalizing patients for injuries due to no fault of their own. Let's not give the American people another reason to believe that Congress is out of touch. Thousands of people die each and every year due to medical malpractice. This is not frivolous.

We had 16 of our Members come forward yesterday to offer amendments. We're going to have 6 hours of debate on six, ostensibly, because we, in the Rules Committee who have the power, refused to waive the power to allow those amendments to come in, some that included things such as not being able to allow a child 3 years old who may have a matter that doesn't manifest itself until he or she is 8 be barred because of time constraints, measures that deal with, like the pediatrician in Delaware who raped 100 or more children, babies, and that position would not be allowed for.

I know that one would argue that some lawsuits are frivolous, and they are. I am a lawyer. I am a trial lawyer, and so I clearly support the trial lawyers, so as how that's understood with my bona fides. But when people are dying, that's not frivolous; and, as I said, people want the best lawyer that they can find.

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

I urge my colleagues to vote ``no'' and to defeat the previous question. I urge a ``no'' vote on the rule, and I do so for the reason that this measure does nothing, is going nowhere, will go to the Senate and will not pass, and everybody in this House knows it.

We have to stop doing nothing and do something for the American people and jobs.

I yield back the balance of my time.

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

I want to thank Mr. Waxman for yielding to me at this time.

I rise in opposition to H.R. 5, brought to the floor by my Republican colleagues. It does two things. It repeals IPAB as created in the Affordable Care Act, and it enacts a medical malpractice reform long sought by my Republican friends as a way to protect pharmaceutical companies, medical device companies, and health care providers from any liability or full liability when they cause harm or death.

The medical malpractice part of this bill is so bad that the California Medical Association rejects the bill and says to vote ``no'' unless they had a decent medical malpractice reform part in it. And when the doctors will reject medical malpractice reform issues, you know it's got to be bad.

This extreme proposal is really not needed. I happen to agree with the part of the bill that repeals IPAB. We refused to include it in the House version of health reform. And Congress has always stepped in in its congressional manner to strengthen Medicare's finances when needed, and I see no need for us to relinquish that duty. We only have to look at the health reform law. It has extended solvency; it has slowed spending growth; it has lowered beneficiary costs; it has improved benefits, modernized the delivery system, created new fraud-fighting tools. We've done a good job. In fact, the CBO projects that IPAB won't even be triggered until the next 10 years, proving we've already done our job here in Congress of strengthening Medicare's finances.

Today's Republican support to repeal IPAB isn't a sincere interest in providing Medicare for all. They still want to give us an unfunded or underfunded voucher, slash and burn funding. And despite my opposition to IPAB, it's far less dangerous to Medicare than the Republican voucher plan put forth in the House Republican budget this week. IPAB doesn't undermine Medicare's guaranteed benefits and its ability to reduce Medicare spending. It has guardrails to prevent it. It doesn't permit costs to come from reducing Medicare and increasing costs on beneficiaries. It prohibits rationing, and it has annual limits on the cuts. The Republican voucher plan has none of these protections.

The Republicans are continuing their march begun by Newt Gingrich to have Medicare ``wither on the vine.'' I urge my colleagues to vote ``no'' on yet another political stunt, which really, thankfully, is not destined to become law at this time.

Sacramento, CA, Mar. 15, 2012.

RE. H.R. 5 Protecting Access to Healthcare Act.

CMA Position. Oppose Unless Amended.

Hon. John Boehner,

Speaker, House of Representatives,

Washington, DC

Hon. Nancy Pelosi,

Minority Leader, House of Representatives,

Washington, DC.

Dear Speaker Boehner and Leader Pelosi: The California

Medical Association has adopted a position of Oppose Unless

Amended on H.R. 5 the ``Protecting Access to Healthcare

Act.'' While we strongly support the repeal of the Medicare

Independent Payment Advisory Board (IPAB) and appreciate the

state preemption of medical liability laws that will preserve

California's successful MICRA law, we have serious concerns

with two additional medical liability provisions that will

expose California physicians to even greater liability

despite the bill's stated legislative intent to reduce health

care costs and insurance premiums.

Support Repeal of the Medicare Independent Payment Advisory Board

(IPAB)

CMA strongly opposes the Medicare Independent Payment

Advisory Board (IPAB) which thwarts Congress' stewardship of

the Medicare program and gives fifteen unaccountable

individuals the power to make significant cuts to Medicare.

We believe it is Congress' responsibility to ensure the

Medicare program meets the needs of their communities. The

IPAB is mandated to make draconian cuts if Medicare spending

exceeds unrealistic budget targets in 2014. While we

appreciate the necessity to control the growth in health care

spending, the IPAB mandate does not leave room to actually

reform the program, particularly because hospitals and other

providers are exempt from the cuts until 2020. It

disproportionately harms physicians who are already

challenged to provide care to Medicare patients with limited

resources. As you know, physicians are facing large Medicare

SGR payment cuts over the next decade as well.

These measures are already forcing more California

physicians to limit the number of Medicare patients they can

accept. If additional cuts take effect, physicians will be

forced to leave the program--harming timely access to quality

care for California's seniors and military families.

The IPAB was not part of the House Health Care Reform bill

because most of the leaders in the California delegation

opposed it. Please continue to stand against an IPAB that

takes important decisions out of your hands.

Medical Liability: Oppose Unless Amended

For the last several decades, California's medical

liability law--MICRA--has successfully protected patients and

physicians. It has kept medical liability insurance

affordable and thus, protected access to care for California

patients while reducing health care costs. CMA appreciates

the provisions in H.R. 5 that allow state preemption and the

preservation of California's important MICRA law. While we

agree with the intent of H.R. 5--to provide MICRA-like

protections for physicians in other states--we have serious

concerns with two provisions that will increase physician

liability costs not only in California but across the

country. We believe these provisions are inconsistent with

the stated intent of the legislation to reduce insurance

premiums and overall health care costs.

1. Fair Share Rule

California has a joint and several liability law that

governs economic damages and allows claimants to recover the

full amount of economic damages from any defendant. The Fair

Share Rule in H.R. 5 will preempt California's law and put

full recovery by injured patients at risk. As written, the

Fair Share Rule will dramatically increase the potential for

physicians to face enforcement proceedings against their

personal assets. This will force physicians to purchase

increased medical professional liability insurance coverage,

which will significantly increase liability premiums in

California for physicians.

Therefore, CMA requests the following amendment that would

allow states with joint and several liability laws to

maintain those important laws.

Page 23, line 4 Add: (b) Protection of States' Rights and

Other Laws.

(1) Any issue that is not governed by any provision of law

established by or under this title (including State standards

of negligence) shall be governed by otherwise applicable

State or Federal law.

(2) This title shall not preempt or supersede any State or

Federal law that imposes greater procedural or substantive

protections for health care providers and health care

organizations from liability, loss, or damages than those

provide by this title or create a cause of action or any

State law that governs the allocation or recovery of damages

among joint tort feasors.

2. No Punitive Damages for Medical Products and Devices

that Comply with FDA Standards

The CMA has serious concerns with granting complete

immunity from punitive damages to medical product and device

manufacturers, distributors and suppliers. We believe this

will force plaintiffs to look only to physicians and other

providers to seek relief and will significantly increase

physician exposure and liability costs. CMA believes that the

United States Supreme Court decision on this issue in Levine

v Wyeth was correct and should remain the law because the

alleged benefits of providing immunity to pharmaceuticals

companies through preemption are far outweighed by the harm

to patient care and physicians.

Therefore. CMA urges that subdivision (c) of Section 106 of

Title I of the Protecting Access to Healthcare Act be

stricken in its entirety.

At the very least, if Title I, Section 106(c) remains in

the bill, the CMA requests the following amendments to

protect physicians from punitive damages liability that would

otherwise be that of the manufacturers and suppliers of

medical products and devices.

Page 10, line 14: (c) No punitive damages for products that

comply with FDA standards

(1) In General (A) No punitive damages may be awarded

against the manufacturer, distributor, or prescriber of a

medical product, or a supplier of any component or raw

material of such medical products, based on a claim that such

product caused the claimant's harm where--

Page 16. Lines 24 25: ``. . . or the manufacturer,

distributor supplier, marketer, promoter, [or] seller, or

prescriber of a medical product, . . .''

Page 17, Lines 15 16: ``. . . or the manufacturer,

distributor supplier, marketer, promoter, [or] seller, or

prescriber of a medical product, . . .''

Page 17, Line 25: ``44. . . or the manufacturer,

distributor supplier, marketer, promoter, [or] seller, or

prescriber of a medical product, . . .''

The CMA urges you to accept these important amendments. We

appreciate the efforts to repeal the IPAB, to protect

California's MICRA law with a state preemption, and to bring

liability relief and lower health care costs to the rest of

the nation.

Thank you for this important work.

Sincerely,

James T. Hay, MD,

President.