EACH Act

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 515 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentleman from Colorado (Mr. Polis), 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.

Mr. Speaker, House Resolution 515 provides for consideration of H.R. 3189, the Water Rights Protection Act, under a structured amendment process, making in order three amendments and providing for extra time for debate for the substitute amendment, which will be offered by Mr. Polis.

The rule also provides for the consideration of H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 with one amendment, offered by Chairman Camp from the Ways and Means Committee, being self-executed in order to ensure that the legislation has a valid pay-for.

This is necessary so that the bill before us does not run afoul with the majority's rule on CutGo. As is customary, the rule allows the minority to offer a motion to recommit on each bill. Finally, the rule provides for the customary district work period authority.

H.R. 3189, the Water Rights Protection Act, addresses a concern of a number of our Western State colleagues who have experienced the Federal Government threatening to take over the private water rights of businesses and private citizens held on public lands.

The bill, sponsored by Representative Scott Tipton from Colorado, is a bipartisan effort to protect water supplies and property rights designated for recreation, agriculture, local conservation, and municipal use from Federal Government overreach.

The bill protects water users and upholds State water laws by prohibiting Federal agencies from extorting water rights through their use of permits, leases, and other land management arrangements.

If the floor debate on this bill is anything like the debate which members of the Rules Committee observed last night, this discussion will be spirited, as this issue deeply affects Western States, where so much of their land is controlled by the Federal Government.

The second bill, H.R. 4015, the SGR repeal legislation, is an issue that I have worked on my entire congressional career. It reflects years of bipartisan, multicommittee, bicameral discussions and negotiations, bringing together Members of all ideological stripes, as well as those from the outside, to coalesce around a policy to help patients and to help their care providers get out from under the constant threat of payment cuts under the current sustainable growth rate structure for Medicare payments.

Everyone agrees, Mr. Speaker, that the Medicare sustainable growth rate has got to go; but today, we are considering an actual framework to realistically accomplish that goal.

This formula--the sustainable growth rate formula--was enacted as part of the Balanced Budget Act of 1997 in an ultimately misguided means by which to restrain Federal spending in Medicare Part B.

The formula consists of expenditure targets, which are established by applying a growth rate, which is designed to bring spending in line with the expenditure targets over time.

Since 2002, this formula has called for a reduction to physician reimbursement rates. However, every Congress has consistently passed legislation to override this formula. This has led this body to find over $150 billion with no solution out of this annual mess.

If Congress were to let the SGR go into effect, physicians would face a 24 percent reduction in reimbursement rates in just a few weeks' time. This unrealistic assumption of spending and efficiency have plagued the health care profession and our Nation's seniors.

The bill before us repeals the SGR--let me repeat that because it is so important--this bill repeals the sustainable growth rate formula, avoiding potentially devastating across-the-board cuts slated for 2014 and does so at a cost far lower than what Congress has already spent or would likely spend over the next 10 years' time.

The bill provides for 5 years of payment transition, essential to allow us to ensure continued beneficiary access, to allow medicine to concentrate on moving to a broad adoption of quality reporting, and allow Congress to move past the distraction of this formula to identify Medicare reforms that can further benefit beneficiaries.

This bill will also allow providers the time to develop and the time to test quality measures and clinical practice improvement activities, which will be used for performance assessment during other phases of this bill. During the 5-year stability period, physicians will receive annual increases of \1/2\ of 1 percent.

I know, I can hear it already. That is not very much. Correct, it is not; but it is more in aggregate than what has been provided over the last several years. More importantly, it provides that stability so physician offices can plan and plan ahead on how to take care of their patients.

The quality measures implemented in what is called the Merit-Based Incentive Payment System will be evidence-based and developed through a transparent process that will seek input from provider groups, from patient groups, and from other stakeholders.

Quality reporting will involve a provider's being judged against its practice rather than a one-size-fits-all, generic standard of care that does not take into account the unique practices of various specialty providers.

Providers will also self-determine their measures. We consolidate three reporting programs into the Merit-Based Incentive Payment System, easing the administrative burden on doctors while retaining the congressionally established goals of quality, resource use, and meaningful use.

The new reimbursement structure ensures continued access to high- quality care while providing physicians with certainty and security in their reimbursements. Physicians will be aware of the benchmarks they are competing against, and unlike current law, all penalties assessed from those not meeting the benchmarks will go to those who are. This keeps the dollars

in the Medicare system, and that, ultimately, drives the quality, which benefits Medicare patients.

Standards against which providers will be measured will be developed by professional organizations in conjunction with existing programs and will incorporate ongoing feedback to doctors, thus further ensuring that optimal care is ultimately provided to the patient.

Realtime feedback will be gained through registries and performance data, and doctors are encouraged to participate in the process through data reporting. For eligible professionals who choose to opt out of the fee-for-service program, alternative payment models will be available. These alternative models may include patient-centered medical homes, whether they are primary or specialty models, and bundles or episodes of care. By encouraging alternative payment models, care coordination, and disease management, our proposed solution will inspire innovation. Qualifying practices that move a significant number of their patients into one of these alternative payment methods will see a 5 percent quality bonus. The bill will also take affirmative steps to improve the accuracy of relative values and misvalued services.

But even though we are taking these important steps toward ensuring quality care, the bill specifically states that these quality measures are not creating a Federal right of action or a legal standard of care or a duty of care owed by the health care provider to the patient.

Mr. Speaker, we have had a lot of discussion. I know my friends on the other side of the dais may disagree with having to pay for new spending, but this is an important reform that Republicans put in place when they reclaimed the majority after the 2010 elections. If you want to increase mandatory spending, you should reduce mandatory spending elsewhere. This is a simple concept, and I know that my constituents and many Americans agree with this.

The Democrats' substitute highlights the difference between the parties on this issue. Democrats have embraced a budget gimmick to offset their bill, a gimmick that even the nonpartisan Congressional Budget Office has said is not scorable. There is no way that it will pay for anything, because the score is zero.

Republicans want to reform Medicare and the payment system in a responsible way and do so in a way that is paid for. If my colleagues on the other side can find a legitimate offset, I am happy to review it. In fact, this is exactly what we are asking of the United States Senate. You don't like our offset. Offer one of your own, and let's work together to pass these much-needed reforms.

This bill is consistent in its themes throughout. We provide payment stability, reduce and streamline the administrative burden, increase predictability in doctors' interactions with the Centers for Medicare and Medicaid Services, build transparency into systems, encourage innovation and the delivery of services, and keep providers in the driver's seat.

I encourage my colleagues to vote ``yes'' on the rule and ``yes'' on the underlying bills.

I reserve the balance of my time.

Mr. Speaker, I yield myself 1 minute to respond to some of this, just to put things in context on a timeline.

H.R. 4015 was introduced on February 6, 2014. The bill has been available to all Members and the public for more than a month. The bill is cosponsored by the bipartisan chairs and ranking members of the Committees on Energy and Commerce, Ways and Means, and the Senate Finance Committee.

We are recommending no changes to the underlying substance of H.R. 4015, which has been negotiated on a bipartisan basis.

I do believe that providing offsets for new spending is an appropriate course of action. Therefore, the Camp amendment saves almost $170 billion over the next 10 years, and this rule ensures that we aren't making future generations foot the bill.

I yield 4 minutes to the gentleman from Colorado (Mr. Tipton).

Mr. Speaker, may I inquire as to the amount of time that remains.

Thank you, Mr. Speaker.

I yield myself 2 minutes.

I wanted to just list some of the exemptions from the individual mandate--those passed in a bipartisan manner by the House of Representatives and those instituted by executive action by the President:

July 17, we delayed the individual mandate until 2015. Twenty-two Democrats voted in favor of that.

March 10, 2014, delayed the individual penalty for individuals who fail to have health care coverage. Twenty-seven Democrats voted in favor.

March 11, H.R. 1814, exempted individuals with certain religious beliefs. Passed by a voice vote. Not a single dissenting vote.

March 11, we exempted volunteer firefighters and emergency responders from the individual mandate. The vote was 410-0. 186 Democrats voted in favor.

March 11, we exempted individuals who receive health coverage under TRICARE, VA, from being counted towards the employer mandate under the ACA. 183 Democrats voted in favor of that exemption.

This is not something that is exclusive to the House of Representatives.

Just last week, the administration quietly excused millions of people from the requirement to purchase health insurance or else pay the tax. Now all you need to do is fill out a form attesting that your plan was canceled and you believe that the plan options available in the marketplace in your area are more expensive than your canceled insurance policy. You believe that to be true. You don't have to prove it. You believe it to be true. It is self-attestation. So the President has already delayed the individual mandate for another 2 years' time.

This is a reasonable proposal, what is out there today. Yes, doctors do need relief, but we need to pay for that. I believe the proposal before the Congress today will do just that.

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

Mr. Speaker, I yield myself 2 minutes.

Mr. Speaker, again I remind the body that this language, this compromise, this bipartisan, bicameral compromise has been available for all to see since February 6. During that time, what response have we gotten from the United States Senate as the responsible way to pay for this legislation? Crickets. Zero. Nothing.

We are offering this bill today with the pay-for that has been embraced by both sides in a bipartisan fashion, as I have demonstrated to you already. This would not be necessary if the Senate had provided us feedback on what their approach to a method of paying for this legislation would be, but they did not.

We know the chairman of the Senate Finance Committee, the Finance Committee in the other body, the chairwoman has now gone to a different occupation, so there is a new chairperson in the other body on the Finance Committee, but that shouldn't have been an obstacle. There was a way forward to provide the discussion, a preconference conference, if you will, because we had all agreed on the policy. This was not a mystery. This was not something that one body had done in secret. This had all been done out in the open for the past 2 years. So that pathway was available.

But for whatever reason, the other body said no deal. We don't want to deal with the House. We want to jam the House at the last minute and get them to accept something. Or better yet, let's just do another patch and get us past our Election Day. That is a very cynical approach.

Mr. Speaker, today before us on the floor we are taking a responsible approach. And guess what. Because we have taken this approach, the Senate is now talking once again about their way forward, which, ultimately, I think is a good thing.

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

As the gentleman from Colorado knows, I am capable of filling whatever volume of time remains on my own, but, no, I don't see other speakers seeking recognition.

I would inquire of the gentleman from Colorado his status of additional speakers.

I am prepared to close.

Mr. Speaker, I yield myself the balance of the time.

Mr. Speaker, I do want to direct Members' attention to yesterday's Wall Street Journal, the article entitled ``ObamaCare's Secret Mandate Exemption,'' which goes into some detail about the self-attestation for the so-called hardship exemption, which the administration included as part of an unrelated rule last week.

As a consequence, there is an exemption from the individual mandate for the next 2 years for anyone who simply wants to go and say: I am sorry; this is too tough for me to do.

Mr. Speaker, today's rule provides for the consideration of two important bills, one dealing with critical water rights and the other addressing the serious problem in the Medicare Sustainable Growth Rate.

I certainly want to thank the gentleman from Colorado (Mr. Tipton) on H.R. 3189, as well as thank the chairmen and the ranking members of the House Committees on Energy and Commerce and Ways and Means, as well as the Senate Finance Committee, for coming together for our Nation's doctors and seniors.

As I close, I would like to note that each committee's work is represented in H.R. 4015. H.R. 4015's base policy has the backing of the House and Senate negotiators and all three committees of jurisdiction. The original cosponsors of the bill include the chairmen and the ranking members of the full committees of jurisdiction, as well as their health subcommittees.

The bill has gained support from the GOP Doctors Caucus, as well as many physicians on the other side of the aisle. We have over 100 bipartisan cosponsors. The bill's policy has been embraced by organized medicine, with well over 700 State and national groups in support of the bill.

From primary care to specialists to surgeons to organized nursing and everyone in-between, we have support for this policy. We will not be able to accomplish this goal without substantive and immediate bipartisan dialogue seeking agreement on reforms to offset the costs associated with the policies in H.R. 4015.

While the delay of the mandate has received bipartisan support, I understand the problems that arise and the opposition that arises.

These reforms must receive the necessary majority support, not only of the House and Senate, but also be agreed to by the White House. However, no one Chamber can negotiate on such an important task in a vacuum.

This action by the House is a means of clearly demonstrating that the legislative policies contained within H.R. 4015 and S. 2000 not only have the support of the committees of jurisdiction and organized medicine, but can gain the necessary support to pass the House.

Mr. Speaker, this is clearly not the end of this conversation. It is another step--another step of many that have been taken in demonstrating to both sides of the Capitol that the committees of jurisdiction have produced significant policy that can serve as the solution to the sustainable growth rate formula that most of us have sought throughout our congressional careers.

Mr. Speaker, I do want to take a moment to thank some of the staff members who have done so much work. I really wanted to start with Dr. John O'Shea, who no longer is on the staff, but now works at the Brookings Institute.

Dr. O'Shea, a physician from New York, was hired by committee staff for the express purpose of helping develop the policy for repealing the sustainable growth rate. In addition, James Decker

on my staff assists me with rules issues.

J.P. Paluskiewicz, known affectionately by his friends as J.P., has put in extraordinary hours on this project, as have Sarah Johnson and Adrianna Simonelli on my personal staff.

On the committee staff, Clay Alspach and Robert Horne have additionally put in hours well above and beyond what ordinarily would be required of committee staff in order to see this project come to fruition.

I certainly want to thank Chairman Upton for making this a priority during his chairmanship of the Committee on Energy and Commerce; and I thank all of the staff--staff on Ways and Means and staff on Senate Finance--who have worked on this issue and will continue to work on this issue until it is solved.

Every success we have had at every point in this process was further than we have ever come before, and that involved a lot of working weekends; but ultimately, if we use this action to springboard to full bicameral engagement on the package that can go to the White House and get signed by the President, indeed, I think all involved would agree that it would be worth it.

I look forward to passage. I look forward to continuing the process with this Chamber and the other Chamber to embrace the underlying policy and ultimately identify the offsets that can get this badly needed policy into law. I urge my colleagues to support the rule and both underlying bills.

[From the Hill, March 13, 2014]

ObamaCare's Secret Mandate Exemption

ObamaCare's implementers continue to roam the battlefield

and shoot their own wounded, and the latest casualty is the

core of the Affordable Care Act--the individual mandate. To

wit, last week the Administration quietly excused millions of

people from the requirement to purchase health insurance or

else pay a tax penalty.

This latest political reconstruction has received zero

media notice, and the Health and Human Services Department

didn't think the details were worth discussing in a

conference call, press materials or fact sheet. Instead, the

mandate suspension was buried in an unrelated rule that was

meant to preserve some health plans that don't comply with

ObamaCare benefit and redistribution mandates. Our sources

only noticed the change this week.

That seven-page technical bulletin includes a paragraph and

footnote that casually mention that a rule in a separate

December 2013 bulletin would be extended for two more years,

until 2016. Lo and behold, it turns out this second rule,

which was supposed to last for only a year, allows Americans

whose coverage was cancelled to opt out of the mandate

altogether.

In 2013, HHS decided that ObamaCare's wave of policy

terminations qualified as a ``hardship'' that entitled people

to a special type of coverage designed for people under age

30 or a mandate exemption. HHS originally defined and

reserved hardship exemptions for the truly down and out such

as battered women, the evicted and bankrupts.

But amid the post-rollout political backlash, last week the

agency created a new category: Now all you need to do is fill

out a form attesting that your plan was cancelled and that

you ``believe that the plan options available in the

[ObamaCare] Marketplace in your area are more expensive than

your cancelled health insurance policy'' or ``you consider

other available policies unaffordable.''

This lax standard--no formula or hard test beyond a

person's belief--at least ostensibly requires proof such as

an insurer termination notice. But people can also qualify

for hardships for the unspecified nonreason that ``you

experienced another hardship in obtaining health insurance,''

which only requires ``documentation if possible.'' And yet

another waiver is available to those who say they are merely

unable to afford coverage, regardless of their prior

insurance. In a word, these shifting legal benchmarks offer

an exemption to everyone who conceivably wants one.

Keep in mind that the White House argued at the Supreme

Court that the individual mandate to buy insurance was

indispensable to the law's success, and President Obama

continues to say he'd veto the bipartisan bills that would

delay or repeal it. So why are ObamaCare liberals silently

gutting their own creation now?

The answers are the implementation fiasco and politics. HHS

revealed Tuesday that only 940,000 people signed up for an

ObamaCare plan in February, bringing the total to about 4.2

million, well below the original 5.7 million projection. The

predicted ``surge'' of young beneficiaries isn't

materializing even as the end-of-March deadline approaches,

and enrollment decelerated in February.

Meanwhile, a McKinsey & Company survey reports that a mere

27% of people joining the exchanges were previously uninsured

through February. The survey also found that about half of

people who shopped for a plan but did not enroll said

premiums were too expensive, even though 80% of this group

qualify for subsidies. Some substantial share of the people

ObamaCare is supposed to help say it is a bad financial

value. You might even call it a hardship.

HHS is also trying to pre-empt the inevitable political

blowback from the nasty 2015 tax surprise of fining the

uninsured for being uninsured, which could help reopen

ObamaCare if voters elect a Republican Senate this November.

Keeping its mandate waiver secret for now is an attempt get

past November and in the meantime sign up as many people as

possible for government-subsidized health care. Our sources

in the insurance industry are worried the regulatory loophole

sets a mandate non-enforcement precedent, and they're

probably right. The longer it is not enforced, the less

likely any President will enforce it.

The larger point is that there have been so many unilateral

executive waivers and delays that ObamaCare must be

unrecognizable to its drafters, to the extent they ever knew

what the law contained.

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

I thank the gentleman for yielding me the customary 30 minutes, and I yield myself such time as I may consume.

Mr. Speaker, we have two bills before us under this rule, which I will briefly discuss before getting into the more important topic of what bills are not being considered on the floor of the House this week.

Notably, despite comprehensive immigration reform's having passed the Senate with more than two-thirds support, despite the fact that there are more than 10 million people here in this country illegally, despite the fact that our borders are porous and that people are sneaking across, as well as illicit goods, despite the fact that we have no meaningful workplace enforcement, despite the fact that farmers and the faith-based community are crying out for reform--the business community, the tech community, labor--there is no immigration bill on the floor of the House today. Instead, we are discussing two bills.

We are discussing one SGR fix. Now, that sounds obscure to people, ``SGR fix.'' What is that? This is the reimbursement rate for doctors under Medicare, and there is a budgetary fiction that long predates me in this place. I assume that, at the time, Republicans and Democrats created this elaborate budgetary fiction together as this degree of budgetary fiction requires both parties' most creative thoughts to possibly put it together. So we pretend every year that there are going to be large cuts to Medicare. I think Republicans and Democrats know that that is not likely to happen. Those cuts would completely gut Medicare. Doctors would drop Medicare patients if those cuts were to occur.

So each year and sometimes shorter than a year--sometimes 6 months, sometimes 3 months, sometimes 2 years--Democrats and Republicans have to come together to figure out how to avoid those automatic cuts that otherwise occur. That discussion is about how to pay for avoiding those cuts each time.

Democrats have suggestions to pay for it--let's eliminate oil and gas loopholes; let's use the overseas contingency fund. Republicans have ideas about how they want to pay for it--in this case, the 52nd repeal of ObamaCare. By the way, they want to keep all of the taxes from ObamaCare; they just want to get rid of some of the benefits. So they are going to keep all of the taxes from ObamaCare--those Republicans love those taxes--but they are getting rid of some of the benefits. That is the secret of what they are using to pay for it, just so you know.

The real discussion is how to do it, but in this case, the Republicans are presumably so embarrassed about their pay-for--the fact that they are using the ObamaCare taxes to pay for Medicare--that they are slipping it into the rule in what is called the ``deem and pass'' language, or what is characterized by some as the ``demon pass'' language.

This rule says:

The amendment printed in part B of the report of

the Committee on Rules accompanying this resolution shall

be considered as adopted.

That means there is not even going to be a vote on the actual way to pay for avoiding the Medicare cuts. It is in the rule, itself. This is the most costly rule I have ever seen. This rule costs $138 billion of ObamaCare taxes that the Republicans want to use. This is an expensive rule, Mr. Speaker. If there is a real desire to talk with Democrats about ways to pay for the Medicare SGR fix, also called the ``doc fix,'' we are happy to do it. We were hoping that you would allow a Democratic pay-for sponsored by Mr. Tierney, who will talk about the previous question. Our idea is to use the Overseas Contingency Fund to avoid any cut to Medicare beneficiaries, but this rule does not allow us to do that. This rule doesn't even allow the House to vote on using ObamaCare taxes to pay for SGR. It includes the ``deem and pass'' language in the rule, itself--a rule, itself, that includes self- executing language that costs $138 billion. That is one expensive rule, Mr. Speaker, and I certainly hope my colleagues vote ``no.''

This rule also includes H.R. 3189, the Water Rights Protection Act. As my colleague said, those of us in the West feel that whiskey is for drinking and water is for fighting about. I think the debate on the Rules Committee last night and the upcoming debate here on the floor will probably reflect that old adage. The genesis of this particular bill is something that Mr. Tipton and I and, I think, many Members of this body agree on. We wanted to address a narrow dispute between the U.S. Forest Service and ski permit holders that directly impacts my district and impacts Mr. Tipton's district.

I support Mr. Tipton's efforts in that regard, and I was hoping we could have gotten the bill to a point where it would have passed near unanimously or unanimously. Instead, this bill has become a job-killing Republican water grab that even the counties that it was designed to help oppose. The counties in my district that have ski resorts--Eagle, Rand, Summit County, famous resorts like Winter Park, Vail, Arapahoe Basin, Breckenridge, among others--now oppose this bill because it will destroy jobs in their counties by destroying recreational opportunities like white-water rafting, fishing, year-round tourism opportunities, which are

critical to the economic success of my district.

These changes to this job-killing Republican water grab have caused this bill to snowball into an effort that will hurt our rivers' health, destroy recreational opportunities, and the underlying bill jeopardizes the agreements that leave waters in streams and rivers, which allow our tourism industry to be so vibrant. Even some of the counties, as we mentioned in the Rules Committee yesterday--certainly not all of those counties--like Pitkin County and the home of Aspen and Mr. Tipton's district, also oppose this bill. Again, there was an overreaching decision by the U.S. Forest Service that required ski area permittees to transfer the ownership of water rights to the Federal Government. In 2012, that water directive was overturned by a U.S. District Court judge.

It is important to note that I believe in the purpose of this bill, and I hope that we can address it through the amendment that I have offered, which allows for 20 minutes of floor debate under this bill. This bill can still be saved by this body's endorsing the amendment that I have offered as part of this bill, which is also supported by ski area representatives from across the Mountain West, along with my colleagues from Colorado Ms. DeGette and Mr. Perlmutter.

Unfortunately, this job-killing Republican water grab bill uses the ski area directive as a pretense for making wholesale job-killing changes. Look, ski areas have been a punching bag for U.S. Forest Service's misguided policies for the last decade. I think we can find common cause around a narrow solution. In that time, the Forest Service has changed the ski area water policies four times. It has inconsistently enforced others' water clauses. It has left ski areas subject to the agency's whim. They are very capital-intense ski areas. They are the major economic driver of the mountain areas of my district, but they have been at the whim of sometimes arbitrary Federal actions. Ski areas collectively hold water rights worth hundreds of millions of dollars that are critical for their businesses.

Now, my colleagues might wonder what kind of improvements a ski area might want to make. In 2011, this body unanimously voted to support the Ski Area Recreational Opportunity Enhancement Act, which allowed ski areas to expand summertime activities, like zip lines and mountain biking. Amongst some of those other summertime activities that ski resorts benefit from are white-water rafting, fishing--the very kinds of recreational opportunities that will be impacted by this job-killing Republican water grab.

I entered several pieces of testimony into the record in the Rules Committee yesterday--statements from water districts and from counties--with regard to how this bill will impact recreational opportunities in Colorado. Along with Ms. DeGette, Mr. Perlmutter, Ms. DelBene, Ms. Kuster, Mr. Cartwright, and Mr. Huffman, I was proud to offer an amendment that would fix and address the issues in H.R. 3189 and return the bill to its original purpose.

The amendment ensures that any U.S. Forest Service directive will not condition ski area permits on the transfer title of any water right or require any ski area permittee to acquire a water right in the name of the United States. The amendment ensures the long-term viability of ski areas, and it makes sure that this bill is not the job-killing Republican water grab that it has become.

It is important to note that the narrow dispute that was the genesis of this bill could have been solved with a suspension measure. We have offered language repeatedly to Mr. Tipton and his staff, to the committee and its staff, but we were not taken up on that offer, sadly. Instead, we have before us a job-killing Republican water grab bill that would devastate my district.

Instead, the manager's amendment was offered, as well as additional language in committee.

This bill is riddled with problems that are not addressed. The bypass flows issue is not solved in the manager's amendment, which does address the Endangered Species Act component but does nothing to address the issues around the Forest Service, BLM, Interior, and Agriculture agencies that also have relevant authority under a number of statutes, including the Federal Land Policy and Management Act, Forest Service and Park Service Organic Act, and Wild and Scenic Rivers Act, to impose bypass flows.

Simply put, the manager's amendment doesn't make the necessary improvements to make this a bipartisan measure--they are simply window dressing for a job-killing Republican water grab.

Let's talk about some of the issues in the underlying legislation.

In the West, water rights are State-based, and any challenge to a right or to the system itself is a very delicate proposition to years of precedence and claims, subordinate and senior, with regard to water.

As a result, this legislation only serves to cast doubt on the complicated laws and authorities that make up our Nation's and State water laws, and that companies, individuals, and counties have made decisions on and already have economic investments in.

In addition, this bill, absent my amendment, muddles the message of disapproval over the 2011 decision.

What exactly are we saying with regard to this bill? A bill that was meant to address the needs of ski areas because of the 2011 directive instead has become an all-encompassing, job-killing Republican water grab, which is not even a clear signal of our unhappiness with the original directive.

I think not only would there be a much cleaner path to actually become the law of the land if we were to consider a targeted approach encompassed by the amendment that I have offered, but it also, even absent becoming law, would send a clear and unambiguous message to the U.S. Forest Service of congressional disapproval of the directive.

Instead, I think they will just shrug their shoulders and say, That is that crazy House of Representatives.

This bill is not going to become law. This bill will not have any impact--and the message is lost with regard to the 2011 directive.

If they think this is the House's reaction--muddled, job-killing, water-grabbing--to this sort of thing, what is to stop them from doing this again? What is to stop them from targeting ranchers? What is to stop them from targeting recreation areas?

When this kind of thing occurs, we need a targeted reaction that can become law or a clear and unambiguous message that the House will not stand for it.

In summary, this rule contains $183 billion in ObamaCare taxes that are spent for another purpose and allows two bills to come to the floor, both of which could be negotiated in good faith with the Democrats, and both of which have not.

I reserve the balance of my time.

Mr. Speaker, I yield 3 minutes to the gentlewoman from Texas (Ms. Jackson Lee), to further discuss the rule that allows for the debate of the job-killing Republican water grab and the bill to keep ObamaCare taxes and remove the benefits.

I yield the gentlewoman an additional 30 seconds.

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

The Republicans are getting worse and worse on these ObamaCare votes. You would think that you would get better with practice, after 52 times they would be better at repealing ObamaCare. That is because this body, the House of Representatives, has voted to repeal ObamaCare, in whole or in part, 52 times.

Those votes started out where it was very simple. The votes were to repeal everything that was in the Affordable Care Act. That is how those votes started. Now they have gotten to the point where the Republicans want to keep the taxes from ObamaCare and get rid of the benefits. I don't think anybody wants that.

I mean, if you are talking about repealing the Affordable Care Act, you still have people that are split on that. You might have a few more people that

agree with you or a few more that agree with us, but the American people have different opinions about that. But if you offered any of them keep all the taxes and get rid of the benefits, I can't imagine anybody wants that.

I would hope that, after so much practice, the Republicans would be quite good at this. It seems to be the core competency they are developing. Almost every week, in fact, this body repeals ObamaCare, but now they are repealing it in a way that keeps all the taxes and gets rid of the benefits; so I am quite surprised that the old adage of ``practice makes perfect'' is far from true with regard to the Republican approach to this bill.

Mr. Speaker, I yield 3 minutes to the gentleman from Wisconsin (Mr. Kind).

Mr. Speaker, I yield the gentleman an additional 45 seconds.

Mr. Speaker, I would like to inquire of the gentleman if he has any remaining speakers.

I am prepared to close. I have 6 minutes, and I wanted to yield to the gentleman if he has remaining speakers who wanted to speak before I close.

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

Mr. Speaker, sadly, with these two bills, while the Republican job- killing water grab bill and the ObamaCare tax bill are both not going to become law, they both have a genesis in a real issue, one that calls for bipartisan cooperation, one that affects the water rights of ski areas that we have offered language in an amendment that would address, the other, my colleague, Mr. Kind, addressed.

This body has a long tradition of coming together around figuring how to pay for SGR. Now, the gentleman mentioned February 6 the language was available. The language regarding the SGR fix is not what is in dispute. The way of paying for the SGR fix is what is the topic of debate between Democrats and Republicans. That language was not seen February 6. That language is not even going to be voted upon under this rule. It is contained in the rule itself.

Sadly, while we take up our time on these bills that are not going to become law, we continue to avoid action on the pressing issue of reforming our immigration system. In August, a number of us sent a letter to Speaker Boehner saying that he should introduce comprehensive immigration reform legislation. If he failed to do so, we would work with a diverse group of our colleagues to introduce a bill for comprehensive immigration reform in the House. There were crickets, and so my colleagues and I, in October, introduced H.R. 15, comprehensive immigration reform, a bill that has bipartisan cosponsors, over 200 sponsors from both sides of the aisle.

Immigration reform is supported by an unprecedented coalition, including business and tech companies, faith leaders from across the country, police, security specialists, but most importantly, the American people, who are sick and tired of having over 10 million people in our country illegally.

We need to restore the rule of law. We need to allow American families to succeed in our country and to live their dreams. We need to have control of our border. We need to implement mandatory workplace authentication to ensure that people who are here illegally cannot work. Every day that passes is a failure of this body to address these issues, and the solution to all of these issues, workplace authentication, securing our border, uniting families, those are all in

Mr. Speaker, unfortunately, but I regret to say unsurprisingly, the Republicans continue to play politics with Medicare, politics with water that is the lifeblood of the American West and the economic lifeblood of the counties that I represent in Eagle and Summit County. And all we have here to vote on today is, once again, an attempt to undermine the Affordable Care Act, to keep the taxes and remove the benefits, and an attempt to grab the water from those who would use it for fishing and recreation in the Mountain West.

I hope that we can do better.

If we can reject this $183 billion rule, I think it will send a message to the Speaker that we are ready for immigration reform.

We are ready to reach out our hand on the SGR, on the doc fix, and figure out the best way to pay for it, taking the best ideas that Republicans and Democrats have to offer, working with the gentleman from Wisconsin (Mr. Kind) and others to bend the cost curve, so that we can deliver a better quality of services to American seniors and contain costs more effectively.

I urge my colleagues to vote ``no'' and defeat the previous question and vote ``no'' on the underlying bills.

I yield back the balance of my time.

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

I thank the gentleman very much.

Might I make a March plea in this March madness?

Can't we all get along and work together on important items such as water rights and the SGR?

I rise, first of all, to make it very clear that I am a strong supporter of providing adequate compensation to our physicians who serve Medicare patients. It is important for our seniors to know that Medicare will be there when they need it. But it is equally important that there are physicians who are willing to attend to them without going broke.

Let it be very clear that I believe my record has been extremely strong on the idea of making sure the benefits for seniors are not cut.

The misrepresentation that the Affordable Care Act cuts Medicare benefits is not true. Now we have the sustainable growth rate, which we had bipartisan support for, and all of a sudden we have a poison pill of a self-executing rule, which was challenged in the Rules Committee, to take money from the Affordable Care Act to allegedly help the doctors.

Every doctor I speak to wants a permanent fix for the SGR. There are a number of suggestions made in the other body, somewhat unpleasant, but we were willing to look at those particular suggestions.

As with any business, medical clinics and physician offices have payrolls to meet, bills to pay, and expenses to meet as they become due. Why are we playing with them when, in essence, we know that this is not going anywhere? Why are we not taking care of these physicians who spend 8 years and hundreds of thousands of dollars to work to gain a degree because they are healers, they believe in it, they want to serve the public. Now, rather than have a bipartisan bill--in the spirit of St. Patrick's Day--and be able to come together and work together, no, we have a bill that poses a serious problem.

I oppose the rule because it corrupts what would otherwise be a strongly supported bipartisan bill to sustain physician reimbursement rates, and it is another attempt, again by our friends on the other side, to disregard and mislead the public about the Affordable Care Act.

Let me clearly say that 11 groups representing the Nation's seniors-- doctors and advocates--sent a letter to congressional leaders urging the House to reject the Republicans' toxic doc fix, the GOP's 51st vote to repeal.

From the letter:

The undersigned organizations representing Medicare

beneficiaries and providers appreciate the bipartisan,

bicameral work done to repeal the Sustainable Growth Rate,

SGR, and reform the Medicare reimbursement system. The

current effort to link, however, SGR reform with changes to

the Affordable Care Act injects partisan politics in

bipartisan legislation.

Access to health care for more than 50 million Americans with Medicare is a serious matter. We should not schedule a vote that does not take seriously the idea of making sure our doctors get sufficient compensation.

The other wrongheaded approach to this is there are no amendments being allowed. No amendments, Mr. Speaker. A closed rule. I just saw some documentation of how many closed rules we have had in this House.

I thank the gentleman.

The Jackson Lee amendment that was not allowed would have ensured that, notwithstanding any provision of this act, no delay in the application of any provision of the Affordable Care Act would have occurred. It would have called for some studies about Medicare providers. It would have given us real information.

Jackson Lee amendment No. 2 would have required the Secretary to submit a report on cost savings.

The real point is, between skewing the water rights of people and the SGR, this rule should be opposed. We should get back to the drawing board.

Can't we all get along and work together on the right kind of legislation for water rights? More importantly, Mr. Speaker, our doctors deserve better, and I will say to them, you will get better from us.

Mr. Speaker, I rise to speak in strong opposition to the Rule for H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014.

Let me say first that I am a strong supporter of providing adequate compensation to our physicians who serve Medicare patients. It is important for our seniors to know that Medicare will be there when they need it. But it is equally important that there are physicians who are willing to attend to them without going broke.

That is why we have a Sustainable Growth Rate or ``SGR.'' Medicare reimbursement enables rural physicians and hospitals to remain open for business.

As with any business, medical clinics and physician offices have payrolls to meet, bills to pay, and expenses to meet as they become due. If revenues are not sufficient to cover costs, the business will not long survive.

Thus, it is critical that we not disrupt timely and adequate payment to Medicare providers.

The problem with H.R. 4015 is what happened in the Rules Committee.

The Rules Committee, on a party line vote, added language to the Rule for H.R. 4015 that would delay the Affordable Care Act's implementation of the individual mandate.

I oppose the Rule for two reasons:

It corrupts what would otherwise be a strongly supported bipartisan bill to sustain physician reimbursement rates for medical services approved under Medicare, and

It is another attempt by the Republicans to mislead the public regarding the Affordable Care Act.

The Jackson Lee Amendments offered to the Rules Committee for H.R. 4015 would have improved the bill by removing the uncertainty that physicians would not keep the reimbursement rates they now have for treating patients under Medicare.

Jackson Lee Amendment #1 would have ensured that notwithstanding any provision of this Act, no delay in the application of any provisions of the Affordable Care Act's individual mandate can take effect before January 21, 2017.

Jackson Lee Amendment #2 would have required the Secretary of Health and Human Services to submit a report to Congress on the impact of the Medicare provider payments on the diversity and availability of physicians and hospitals to underserved rural and urban communities.

Jackson Lee Amendment #3 would have required the Secretary of Health and Human Services to submit a report to Congress on the cost savings associated with people no longer using emergency rooms or acute care facilities as their primary means of obtaining health care.

Jackson Lee Amendment #4 would ensure that the bill cannot be construed or interpreted to permit or require a delay in the application of the Affordable Care Act's individual mandate.

I know that many predicted that the Affordable Care Act would cause havoc on the nation's health care system. But it is not the ACA that is causing havoc--it is the 50 desperate but futile attempts by the Tea Party to scuttle a law that has been passed by Congress, signed by the President, upheld by the Supreme Court.

The most threatening actions to our nation's healthcare system by Tea Party Republicans are their attacks on Medicare.

In 2014, according to the Kaiser Foundation 16% of the nation's people have medical insurance under Medicare:

Texas has 12% of its residents insured under Medicare;

Arkansas, Florida and Vermont have 19% of their residents insured under Medicare; and

West Virginia and Main have 21% of their residents insured under Medicare.

Kentucky; Mississippi, Missouri, Ohio, Oklahoma, Oregon, South Dakota, Tennessee, Wisconsin, Ohio, Oklahoma, and Oregon have 18% of their residents insured under Medicare.

Every state has more than 10% of their residents insured by Medicare.

The uncertainly created by the majority regarding Medicare reimbursement over the last several years has forced physicians to reevaluate continuing their medical practice and frustrated hospitals working to make budget projections over several years into the future-- this is critical to business decision making.

Because of uncertainty created by Medicare physician reimbursement-- physicians and hospitals have been forced to close their offices, reduce services, or merge.

When patients find they cannot keep their physician or that their options for health care are being affected--it is not because of the Affordable Care Act.

Our nation has taken a momentous step in creating a mindset that good health is a personal responsibility with the enactment of the Affordable Care Act. The health care law did not automatically enroll all citizens into the program; it was specifically designed to be an opt-in process.

There are tens of thousands of visitors each day to the website and despite problems with the initial rollout of the online health insurance registration process, millions have enrolled and experience the peace of mind that comes from having affordable, high quality health insurance that is there when you need it.

I have held many events in my District to inform and connect people with Navigators and Community Health Centers and send a strong message to my constituents encouraging them that now is the time for them to obtain affordable, accessible, and high quality health insurance for themselves and their families.

So it is puzzling that with less than 70 legislative days remaining in the Second Session of the 113th Congress, we are still seeing attempts to end the Affordable Care Act.

The fact that a bill that is critical to the provision of payments to physicians that treat Medicare patients is not safe from the politics of the moment is troubling.

I ask my colleagues to support Medicare patients and their physicians by rejecting this Rule.

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 1814) to amend section 5000A of the Internal Revenue Code of 1986 to provide an additional religious exemption from the individual health coverage mandate.

Mr. Speaker, I ask unanimous consent that all Members have 5 legislative days in which to revise and extend their remarks and to include extraneous material on the subject of the bill under consideration.

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

Just yesterday, a Washington newspaper headline read: ``Worst Congress Ever.''

The thrust of the article was an indictment against Washington partisanship for its failure to move significant legislation on behalf of the American people. Now, to some degree, I suppose we have all felt at times that Congress just isn't making any laws. Of course, there are times, however, when Congress must make no law if we are to honor the oath we have sworn, which is to support and defend the Constitution of the United States. Indeed, ``Congress shall make no law respecting the establishment of religion or prohibiting the free exercise thereof.''

Today, we have the opportunity to work together, across the aisle, to reaffirm this founding principle of our democracy. Together, we will reinforce the constitutional protection for sincere believers of all faiths against the unnecessary entanglement of government with their private religious expression. H.R. 1814 slightly expands the religious conscience exemption of the Affordable Care Act to include individuals with ``sincerely held religious beliefs'' among those eligible for an exemption from the individual mandate penalty.

In order to qualify for the exemption under the EACH Act, an individual must affirm on an annual tax return that he or she cannot purchase coverage due to a sincerely held religious belief. This term, as defined by the U.S. Equal Employment Opportunity Commission and as widely recognized by

the courts, is designed to protect various types of religious believers, not just those who belong to a traditional, organized religion.

Today's bill must become law. Among the many problems with the Affordable Care Act, the current conscience exemption only protects the religious exemptions of a few select faiths. Now, I am fully aware that not every organization purporting to defend religious liberty is in favor of today's measure. I am, nevertheless, thankful that my good friend from the other side of the aisle, Mr. Keating, joined me in this effort. His home State of Massachusetts incorporated a similar religious liberty exemption in their State law, and it seems to be working out just fine. Since the law passed, only 6,500 Bay Staters have claimed the conscience exemption.

This fact serves to reinforce the very principle of religious liberty we affirm today. The Constitution does not only protect the religious practices and beliefs of majority faith traditions, but, rather, the First Amendment protects even the smallest faith group and even the single individual against laws that infringe upon their sincerely held religious beliefs.

Yet H.R. 1814 isn't only about constitutional jurisprudence and legislative correctness. It is about real people in my district and in yours who feel that their free exercise of religion is encumbered under the current law. One of them is a constituent of mine named Andrew, who lives in Chillicothe, Illinois. Andrew is a sincere believer whose religious commitment leads him to pursue only nonmedical health care options. According to Andrew, under the current law, he will be required to pay a fine once the individual mandate penalty kicks in. Regrettably, Andrew's religious beliefs were not considered when the present conscience exemption was enacted.

Today, the EACH Act gives individuals like Andrew the ability to practice his religious beliefs without coercive government fining him for coverage he does not intend to use nor can he use and remain true to his most sincere religious beliefs. We recognize, however, that the immense unpopularity of ObamaCare among many Americans might entice otherwise law-abiding citizens to claim an exemption under the EACH Act in order to escape the law's penalty. In order to ensure that individuals do not game the system, this bill includes a strong provision that revokes the exemption and requires the individual to pay a stiff penalty if he or she seeks medical treatment at any point during that year.

H.R. 1814 walks that fine line between protecting the First Amendment for every American and safeguarding taxpayers against potential fraud. Congress has long sought to uphold both of these commitments, and, today, this bill affords us a bipartisan opportunity to do it once again. I urge my colleagues to support this important fix to the Affordable Care Act and to pass H.R. 1814.

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

Mr. Speaker, I appreciate my friend's comments from California. I would just remind the gentleman that this is a near carbon copy of language that was implemented in the State of Massachusetts. It has had a very minimal effect, and it has impacted and has helped a very small number of people. It is why this bill has received such bipartisan support and is on the suspension calendar here tonight.

With that, I yield 1 minute to the gentlelady from Tennessee (Mrs. Black), my good friend.

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

Mr. Speaker, I yield 1 minute to my good friend and neighbor from Illinois (Mr. Rodney Davis).

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

I would just remind my good friend from Michigan that had regular order been used when ObamaCare was passed, perhaps we would not be attempting to try and fix it now that it is law.

The U.S. Supreme Court upheld ObamaCare in a 5-4 ruling 2 years ago this summer. The Justices did so by affirming that Congress, contrary to the repeated assurance by my colleagues on the other side of the aisle, had effectively created a tax that falls under the enumerated powers of article I of the Constitution, and, like a tax, compliance is mandatory, and enforcement is the job of the Internal Revenue Service.

Since the summer of 2012, we have learned some things about the IRS that raise concerns about the agency's ability to do its job fairly. Likewise, we have watched the Obama administration usurp congressional authority and refuse to enforce the law that bears the President's name.

Among the many ``executive fixes'' that seem to flow from the administration with increasing frequency, none have touched upon one of the most serious problems with ObamaCare, namely, current law will either force millions of Americans to violate their sincerely held religious beliefs or punish them for exercising those beliefs.

We are not likely to agree today--or any day--on the underlying law. ObamaCare is as controversial now--and perhaps even more so--than when it was passed, but we can agree on this:

Congress shall make no law respecting the establishment of

religion or prohibiting the free exercise thereof.

Less than a mile from this Chamber, on the bank of the tidal basin, are inscribed in marble these words:

Almighty God hath created the mind free. All attempts to

influence it by temporal

punishments or burdens are a departure from the plan of the

Holy author of our religion. No man shall suffer on account

of his religious opinions or belief, but all men shall be

free to possess and maintain their opinions in matters of

religion.

Those words, written by Thomas Jefferson, the first Democrat to be called ``Mr. President,'' capture the very essence of today's bill. It is our duty--even our oath that we take before God--to protect the religious freedoms of every American. ObamaCare does not do that. Today's bipartisan measure is a small but necessary step if Congress is to honor the great tradition of religious liberty enshrined in our founding documents and extended to succeeding generations of Americans by law.

Mr. Speaker, I urge passage of H.R. 1814, and I yield back the balance of my time.

Mr. Speaker, it is now my pleasure to yield such time as he may consume to the gentleman from California (Mr. Waxman), the ranking member on the Energy and Commerce Committee.

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

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

Mr. Speaker, in closing, I yield myself the balance of my time.

I respect very much the specific impetus for this bill. Unfortunately, though, there have been no hearings on this legislation, and it was not marked up in committee.

I would like to provide information on current law, on the scope of this legislation, and its potential consequences on our health care system.

This is why I do not support this bill in its present form.

First, it is important to note that the Affordable Care Act contains a religious exemption incorporating one that has been in the Internal Revenue code since 1965. This provision permits an exemption to members of religion that join together to provide mutual aid as a community-- for example, the Amish and Mennonite faiths--or participate in a health care sharing ministry, which is akin to insurance. These groups do not participate in government-funded social services, including Medicare or Social Security. This is a longstanding, well-defined, easy to implement exemption, and it was carried over to the ACA.

The ACA's minimum essential coverage requirement was challenged in Federal court under the Religious Freedom Restoration Act. The court rejected the challenge, concluding that ACA did not impose a substantial burden on plaintiffs' religious exercise, despite claims that the plaintiffs ``believe in trusting in God to protect them from illness or injury'' and did not ``want to be forced to buy health insurance coverage.''

Second, a requirement to purchase minimum health insurance is not a burden on one's exercise of their religious beliefs in the medical treatment they seek. The ACA does not preclude coverage for spiritual healing or prayer treatments. Indeed, the Church of Christ, Scientist explains on their Web site that under current law:

Various U.S. Federal, State, and private health insurance

plans provide for the reimbursement of Christian Science

nursing care and practitioner treatment.

Christian Scientists participate in Medicare, and Medicare covers some Christian Science services.

It is the breadth of the language in the bill and the potential unintended consequences implementing it on a national basis that concerns me.

The language provides an exemption if a person files a sworn statement to the IRS that their ``sincerely held religious beliefs'' would cause them to object to the ``medical health care'' that would be covered under ACA's minimum essential health care requirement.

There is no indication as to how the IRS could implement this provision and, as a result, the exemption could essentially be available to anyone opposed to the ACA. While the bill states that individuals receiving ``voluntary'' medical care would lose their exemption, the IRS has no way to monitor individuals' use of voluntary medical care and to enforce this provision.

Under the legislation, individuals receiving ``involuntary'' care-- such as emergency care--would be allowed to remain exempt from the coverage requirement, passing the cost of such care on to hospitals and other taxpayers.

Because the bill does not define the ``sincerely held religious beliefs'' an individual would need to cite to avoid purchasing coverage, the IRS would be forced to determine which Americans' beliefs met the standard. Yet just 2 weeks ago, the House considered and passed H.R. 2531, the Protecting Taxpayers from Intrusive IRS Requests Act, that specifically prevented the IRS from asking taxpayers about their religious, political, or social beliefs.

I regret that normal order has not been followed on H.R. 1814 so that these concerns could be surfaced and further information on the broad and problematic consequences of H.R. 1814 considered.

For example, today, the American Academy of Pediatrics just expressed their concerns about the impact of H.R. 1814 on children. The American Civil Liberties Union also opposes the legislation, and the CBO just indicated today that the bill would increase the deficit by $1.5 billion over 10 years and increase the uninsured by about 500,000 each year.

Current religious exemptions in the Tax Code are circumscribed and well-defined. This bill would create a broad and difficult to determine exemption in the individual responsibility requirement and force the IRS to take on an inappropriate role. Congress should take a more careful approach to this issue.

I yield back the balance of my time.