Providing for consideration of the bill (H.R. 849) to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board.

Mr. Speaker, I rise today in support of the rule for my bill, H.R. 849, the Protecting Seniors' Access to Medicare Act of 2017.

Mr. Speaker, this bill would repeal the Independent Payment Advisory Board, or IPAB, which was created solely as a cost containment mechanism as part of the Affordable Care Act. It has nothing to do about quality of care or access to care. I can't think of anything more important, Mr. Speaker, that this Congress should be doing than providing quality care and access to care for our senior citizens of this country, some 58 million of them.

Whatever your feelings may be about the ACA, this provision has had strong bipartisan opposition from its beginning, and it was not contained in the House Democrat's version of the bill, but was jammed in by the Senate at the end.

If you still need convincing on just how unpopular this provision of the law is, ask yourself: How often do we see a bill come to the floor under a rule that has 270 bipartisan cosponsors?

Passing this bill will send a strong message to our Senate colleagues that the time to act is now.

Mr. Speaker, the overwhelming bipartisan support for Members is only outdone by the overwhelming nationwide coalition of support.

Mr. Speaker, I include in the Record a letter from the Protect My Doctor and Me coalition, a letter that has been signed by nearly 800 groups representing patients, providers, and all sectors of the healthcare industry with support in all 50 States.

September 6, 2017.

Dear Member of Congress: The undersigned organizations--

representing Medicare beneficiaries and patients, all sectors

of the healthcare industry as well as employers and other

purchasers of health care--believe strongly that the Medicare

program must protect patient access to quality healthcare.

The Independent Payment Advisory Board (IPAB), a provision of

the Patient Protection and Affordable Care Act (PPACA), not

only poses a threat to that access but also, once activated,

will shift healthcare costs to consumers in the private

sector and infringe upon the decisionmaking responsibilities

and prerogatives of the Congress. We request your support to

repeal IPAB.

IPAB, as constructed under PPACA, is a board comprised of

Presidential appointees who will be charged with making

recommendations to cut Medicare expenditures if spending

growth reaches an arbitrary level. Once the Secretary of

Health and Human Services (HHS) implements an IPAB

recommendation, that action is not subject to administrative

or judicial review. As constructed, IPAB is granted

unprecedented powers--even the ability to change laws

previously enacted by Congress--with virtually no oversight.

The potential impact of this board causes deep concern

among our organizations and the millions of Americans we

represent. IPAB proponents suggest that the board will be an

asset in developing needed healthcare delivery reforms. That

goal, however, is not realistically achievable. The law

requires IPAB to achieve scoreable savings within a one-year

time period. Thus, instead of pursuing long-term reforms that

may not achieve immediate savings, IPAB is more likely to

consider short-term savings in the form of payment cuts for

healthcare providers. This was, in fact, the conclusion of

the Congressional Budget Office, which stated that IPAB is

most likely to focus on payment rates or methodologies for

services provided by non-exempt providers.

This would be devastating for patients, affecting access to

care and innovative therapies. Already, the number of

physicians unable to accept new Medicare patients due to low

reimbursement rates has been increasing over the past several

years. IPAB-generated payment reductions would only increase

the access difficulties faced by too many Medicare

beneficiaries. Furthermore, payment reductions to Medicare

providers will almost certainly result in a shifting of

health costs to employers and consumers in the private

sector.

Under IPAB's provisions, the responsibility for enacting

healthcare system changes of this magnitude would be

transferred from the legislative branch to the executive.

More specifically, an unelected board without adequate

oversight or accountability would be taking actions

historically reserved for the public's elected

representatives in the U.S. House and Senate. This is an

unacceptable decisionmaking process for a program that

millions of our nation's seniors and individuals with

disabilities rely upon.

Moreover, if IPAB does not act within the law's required

timeframe or if IPAB members are not appointed by the

President or confirmed by the Senate, the law transfers

IPAB's responsibilities solely to the HHS Secretary. This

places an enormous degree of power in the hands of one

unelected individual.

We strongly support bringing greater cost-efficiency to the

Medicare program. We also advocate continuing efforts to

improve the quality of care delivered to Medicare

beneficiaries.

The Independent Payment Advisory Board will achieve neither

of these objectives and will only weaken, not strengthen, a

program critical to the health and well-being of current and

future beneficiaries. We urge Congress to eliminate the IPAB

provision.

Sincerely,

1 in 9: The Long Island Breast Cancer Action Coalition; 60

Plus Alabama; 60 Plus Association; A Partnership of

Diabetics; Abbott; Actelion Pharmaceuticals; Action CF; ADAP

Advocacy Association (aaa+); AdvaMed--the Advanced Medical

Technology Association; Advocacy Council of ACAAI; Advocates

for Responsible Care (ARxC); AIDS Alliance for Women,

Infants, Children, Youth & Families; AIDS Community Research

Initiative of America; AIDS CT; AIDS Foundation of Chicago;

AIDS Outreach Montana; AIDS Resource Center Ohio; AIDS

Response Seacoast; AIDS Services for the Monadnock Region;

Alabama ACEP.

Alabama Association of Ambulatory Surgery Centers; Alabama

Council of Community Mental Health Boards; Alabama Hospital

Association; Alabama Lifespan Respite Resource Network;

Alabama Podiatric Medical Association; Alabama Society for

Clinical Social Work; Alabama Society for the Rheumatic

Diseases; Alaska Behavioral Health Association; Alaska ACEP;

Alaska Rheumatology Alliance; Alaska State Medical

Association; Alliance for Patient Access; Alliance of

Specialty Medicine; Alzheimer's & Dementia Alliance of

Wisconsin; Alzheimer's Arkansas; Alzheimer's Association--

Capital of Texas Chapter; Alzheimer's Texas; American Academy

of Allergy, Asthma & Immunology; American Academy of

Dermatology Association; American Academy of Facial Plastic

and Reconstructive Surgery.

American Academy of Neurology; American Academy of

Ophthalmology; American Academy of Otolaryngology-Head and

Neck Surgery; American Academy of Physical Medicine &

Rehabilitation; American Association for Hand

Surgery; American Association for Pediatric Ophthalmology

and Strabismus; American Association of Clinical

Endocrinologists; American Association of Clinical

Urologists; American Association of Hip and Knee Surgeons;

American Association of Neurological Surgeons; American

Association of Oral and Maxillofacial Surgeons; American

Association of Orthopaedic Surgeons; American Autoimmune

Related Diseases Association; American Behcet's Disease

Association; American College of Allergy, Asthma &

Immunology; American College of Cardiology; American

College of Emergency Physicians (ACEP); American College

of Mohs Surgery; American College of Osteopathic Family

Physicians; American College of Osteopathic Surgeons.

American College of Radiology; American College of

Rheumatology; American College of Surgeons; American Congress

of Obstetricians & Gynecologists; American Congress of

Obstetricians & Gynecologists, Oklahoma Chapter; American

Gastroenterological Association; American Glaucoma Society;

American Kidney Fund; American Liver Foundation; American

Liver Foundation Pacific Coast Division; American Medical

Association; American Military Society; American Nurses

Association; American Orthopaedic Foot and Ankle Society;

American Orthopaedic Society for Sports Medicine; American

Osteopathic Academy of Orthopedics; American Osteopathic

Association; American Osteopathic College of Rheumatology;

American Physical Therapy Association; American Podiatric

Medical Association.

American Shoulder and Elbow Surgeons; American Society for

Dermatologic Surgery Association; American Society for Mohs

Surgery; American Society for Surgery of the Hand; American

Society of Anesthesiologists; American Society of Cataract

and Refractive Surgery; American Society of Echocardiography;

American Society of Nuclear Cardiology; American Society of

Ophthalmic Administrators; American Society of Ophthalmic

Plastic and Reconstructive Surgery; American Society of

Plastic Surgeons; American Spinal Injury Association;

American Urological Association; American Uveitis Society;

AmerisourceBergen; Amgen; AMN Healthcare; Arizona Bioindustry

Association (AZBio); Arizona College of Emergency Physicians;

Arizona Radiological Society.

Arizona United Rheumatology Alliance; Arizona Urological

Society; Arkansas Chapter ACEP; Arkansas Medical Society;

Arkansas Ophthalmological Society; Arkansas Orthopaedic

Society; Arkansas Podiatric Medical Association; Arkansas

Rheumatology Association; Arthritis Foundation; Arthritis

Foundation South Central Region; Arthroscopy Association of

North America; Ascension; Association of Black Cardiologists;

Association of University Professors in Ophthalmology; Asthma

and Allergy Foundation of America; Asthma and Allergy

Foundation of America, New England Chapter; Atrius Health;

Austin Radiological Association; BEACON--Biomedical

Engineering Alliance & Consortium; Better Medicare Alliance.

Bingham County Senior Center; Bio Nebraska Life Sciences

Association; BioBuzz Workforce Foundation; Biocom;

BioFlorida; BIOForward; BioHouston; BioKansas; BioNJ;

BioNorthTX; BioOhio; Bioscience Association of West Virginia;

Biotechnology Industry Organization (BIO); BioUtah;

Birmingham Neurosurgery and Spine Group, PC; Brain Injury

Alliance of Oregon; Brain Injury Association of Nebraska;

California Academy of Eye Physicians and Surgeons; California

ACEP; California Asian Pacific Chamber of Commerce;

California Association of Health Facilities; California

Association of Neurological Surgeons, Inc; California Chronic

Care Coalition.

California Health Collaborative, California Hepatitis C

Task Force; California Life Sciences Association--CLSA;

California Medical Association California Orthopaedic

Association; California Podiatric Medical Association;

California Rheumatology Alliance; California Senior

Advocates League; California Society for Cardiac

Rehabilitation; California Urological Association;

Cambridge Chamber of Commerce; Campbell Clinic; Caregiver

Action Network; Center for Health Care Services; Center

for Healthcare Innovation; Center of Health Engagement;

Central Coast Medical Society; Central Florida Behavioral

Health Network; Centro de mi Salud; Cervical Spine

Research Society.

Charleston Parkinson's Support Group; Chattanooga-Hamilton

County Medical Society; Chemed Corporation; Citrus Council

NKFF; City of New Orleans; Cleveland Clinic; CNY HIV Care

Network; COAAA; Coalition of Asian-American IPA; Coalition of

State Rheumatology Organizations (CSRO); Colon Cancer

Alliance; Colorado BioScience Association; Colorado Cross-

Disability Coalition; Colorado Gerontological Society;

Colorado Medical Society; Colorado Podiatric Medical

Association; Colorado Radiological Society; Colorado

Rheumatology Association; Colorado Society of Eye Physicans &

Surgeons; Colorado's Insurance Consultant, LLC.

Communicating for America, Inc.; Community Access National

Network (CANN); Community Health Action Network; Community

Health Charities of Nebraska; Community Liver Alliance;

Community Oncology Alliance; Congress of Neurological

Surgeons; Connecticut Orthopaedic Society; Connecticut

Podiatric Medical Association; Council for Affordable Health

Coverage; Council of State Neurosurgical Societies; CPEM,

Inc; Crohn's & Colitis Foundation of America, Georgia

Chapter; CSRA Area Agency on Aging; Delaware Academy of

Ophthalmology; Delaware Ecumenical Council on Children and

Families; Delaware HIV Consortium; Dia de la Mujer Latina;

Easter Seals; Easter Seals Central and Southeast Ohio Inc.

Easter Seals Central Texas; Easter Seals Iowa; Easter Seals

Massachusetts; Easter Seals Nebraska; Easter Seals North

Georgia; Easter Seals of Southeastern PA; Eastern Orthopaedic

Association; EDSers United Foundation; Eisai Inc.; Eli Lilly

and Company; ELLAS; Emergency Department Practice Management

Association; Enchantment Healthcare; Endometriosis

Association; Enterprise Family Healthcare; Epilepsy

Association of the Big Bend; Epilepsy Foundation of Greater

Chicago; Epilepsy Foundation of Greater Southern Illinois;

Epilepsy Foundation of Hawaii; Epilepsy Foundation of San

Diego County.

Epilepsy Foundation of Western Wisconsin; Familia Unida

Living with MS; FCEP Florida College of Emergency Physicians;

Federation of American Hospitals; Federation of Families for

Children's Mental Health--CO Chapter; First Step House; Fleet

Reserve Association; Florida Allergy, Asthma & Immunology

Society; Florida Neurosurgical Society; Florida Orthopaedic

Society; Florida Osteopathic Medical Association; Florida

Partners in Crisis; Florida Podiatric Medical Association;

Florida Society of Dermatology and Dermatologic Surgery;

Florida Society of Rheumatology; Florida State Hispanic

Chamber of Commerce; Friends of Our Lady of Good Counsel;

Geaux Group; Georgia Bio; Georgia College of Emergency

Physicians.

Georgia Commission on Women; Georgia Neurosurgical Society;

Georgia Orthopaedic Society; Georgia Osteoporosis Initiative;

Georgia Podiatric Medical Association; Georgia Society of

Clinical Oncology;

Georgia Society of Dermatology and Dermatological Surgery;

Georgia Society of Ophthalmology; Georgia Society of

Rheumatology; Georgia Women's Institute; Global Genes; Global

Healthy Living Foundation; Global Liver Institute; Granite

State Taxpayers; Greater North Dakota Chamber; Greater

Providence Chamber of Commerce; H.E.A.L.S of the South

(Hepatitis Education, Awareness and Liver Support); Hawaii

ACEP; Hawaii Independent Physicians Association; Hawaii

Medical Association.

Hawaii Podiatric Medical Association; Health Agents for

America, Inc. (HAFA); Healthcare Innovation Exchange;

HealthCare Institute of New Jersey (HINJ); Healthcare

Leadership Council; HealthHIV; Healthy African American

Families; Hispanic CREO; Home Care Association of Washington;

Hopkins County Memorial Hospital; ICAN, International Cancer

Advocacy Network; Idaho Association of Nurse Anesthetists;

Idaho Medical Association; Idaho Orthopaedic Association;

Idaho Orthopaedic Society; Idaho Osteopathic Physicians

Association; Idaho Podiatric Medical Association; Idaho State

Dental Association; Illinois Biotechnology Innovation

Organization; Illinois College of Emergency Physicians.

Illinois Manufacturers' Association; Illinois Neurological

Institute; Illinois Podiatric Medical Association; Illinois

Society of Eye Physicians & Surgeons; Illinois State

Ambulance Association; Illinois State Medical Society;

INACEP; Independent Medical Providers Action Council; Indiana

Academy of Ophthalmology; Indiana Health Industry Forum;

Indiana Medical Device Manufacturers Council; Indiana

Neurosurgical State Society; Indiana Podiatric Medical

Association; Indiana State Medical Association; Indiana

University Health, Inc.; Infectious Diseases Society of

America; Insight Human Services; Integral Rheumatology and

Immunology Specialists (IRIS); International Foundation for

Autoimmune Arthritis; International Institute of Human

Empowerment.

International Society for the Advancement of Spine Surgery;

ION Solutions; Iowa Academy of Ophthalmology; Iowa ACEP; Iowa

Biotechnology Association; Iowa Orthopaedic Society; Iowa

Osteopathic Medical Association; Iowa Podiatric Medical

Society; Iowa State Grange; J. Robert Gladden Orthopaedic

Society; JobKeeper Alliance; Johnson & Johnson; Julian CNA

Training School; Kansas Association of Osteopathic Medicine;

Kansas Orthopaedic Society; Kansas Podiatric Medical

Association; Kansas Rheumatology Alliance; Kansas Society of

Eye Physicians & Surgeons; Kansas Urological Association;

Kendall Square Association.

Kentuckiana Rheumatology Alliance; Kentucky Academy of Eye

Physicians and Surgeons; Kentucky ACEP; Kentucky Chamber of

Commerce; Kentucky Life Sciences Council; Kentucky Medical

Association; Kentucky Psychiatric Medical Association; Kidney

Cancer Association; Kidney Care Partners; Latin American

Chamber of Commerce; Latino Commission on AIDS; Latino

Diabetes Association; Licensed Professional Counselors

Association; Life Science Tennessee; Life Sciences Greenhouse

of Central PA; Life Sciences Pennsylvania; Limb Lengthening

and Reconstruction Society; Louisiana Alumni, Sigma Kappa

GNO; Louisiana Association of Neurological Surgeons;

Louisiana Liberty 64.

Louisiana Lifespan Respite Coalition; Louisiana Orthopaedic

Association; Louisiana Podiatric Medical Association;

Louisiana Womens' Network; Lower New York Chapter, The

American Association of Clinical Endocrinologists; Lupus

Alliance of Long Island/Queens; Lupus Alliance of Upstate New

York; Lupus and Allied Diseases Association;

Lupus Foundation New England; Lupus Foundation of America;

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

Foundation of Arkansas, Inc.; Lupus Foundation of Colorado;

Lupus Foundation of Florida, Inc.; Lupus Foundation of

Northern California; Lupus Foundation of PA; Lupus Foundation

of Southern California; Lupus LA; Lupus Society of Illinois;

MA Health Council.

MACEP--Massachusetts College of Emergency Physicians; Maine

ACEP; Malecare Cancer Support; Mallinckrodt Pharmaceuticals;

Manufacture Alabama; Maryland Chapter American College of

Emergency Physicians; Maryland Orthopaedic Association;

Maryland Society of Eye Physicians and Surgeons;

Massachusetts Association for Mental Health, Inc;

Massachusetts, Maine, and New Hampshire Rheumatology

Association; Massachusetts Medical Device Industry

Council (MassMEDIC); Massachusetts Medical Society;

Massachusetts Orthopaedic Association; Massachusetts Society

of Eye Physicians and Surgeons; MassBio; Maxim Healthcare

Services; Maxima Home Health LLC; Meals on Wheels North

Carolina; MedChi, The Maryland State Medical Society; Medical

Alley.

Medical Association of Georgia; Medical Association of the

State of Alabama; Medical Device Manufacturers Association

(MDMA); Medical News; Medical Oncology Association of

Southern California; Medical Society of New Jersey; Medical

Society of the State of New York; Medical University of South

Carolina (MUSC); MedTech Association; MemorialCare Health

System; Mended Hearts; Men's Health Network; Mental Health

America of Montana; Mental Health Systems; Merck;

Metropolitan Milwaukee Association of Commerce; Michigan

Association of Neurological Surgeons; Michigan Association of

Osteopathic Family Physicians; Michigan Biosciences Industry

Association--MichBio; Michigan Chamber of Commerce.

Michigan College of Emergency Physicians; Michigan Lupus

Foundation; Michigan Orthopaedic Society; Michigan

Osteopathic Association; Michigan Rheumatism Society;

Michigan Society of Eye Physicians and Surgeons; Minnesota

Academy of Ophthalmology; Minnesota Chapter ACEP; Minnesota

Medical Association; Minnesota Neurosurgical Society;

Minnesota Organization of Registered Nurses; Minnesota

Orthopaedic Society; Minnesota State Grange; Mississippi

Academy of Eye Physicians and Surgeons; Mississippi

Osteopathic Medical Association; Mississippi Society of Eye

Physicians and Surgeons; Mississippi State Medical

Association; Missouri Ambulance Association; Missouri

Association of Rural Health Clinics; Missouri Biotechnology

Association.

Missouri Chamber of Commerce and Industry; Missouri

Hospital Association; Missouri State Medical Association;

Missouri Urological Society; MoCEP--Missouri College of

Emergency Physicians; Montana ACEP; Montana BioScience

Alliance; Montana Chamber of Commerce; Montana Medical

Association; Montana Orthopedic Society; Multiple Sclerosis

Resources of Central New York, Inc; Musculoskeletal Tumor

Society; NAMI--Sheridan; NAMI Alabama; NAMI Anchorage; NAMI

Buffalo & Erie County; NAMI Clackamas; NAMI Florida; NAMI

Greater Des Moines; NAMI Hernando.

NAMI Illinois; NAMI Indiana; NAMI Iowa; NAMI Kansas; NAMI

Knox Licking County Ohio; NAMI Lewis County; NAMI Maine; NAMI

Maryland; NAMI Mass; NAMI Minnesota; NAMI Montana; NAMI

Nebraska; NAMI Nevada; NAMI New Mexico; NAMI North

Carolina; NAMI North Dakota; NAMI Northern Nevada; NAMI

Ohio; NAMI Rochester; NAMI Sioux Falls.

NAMI Skagit; NAMI Stark County; NAMI Upper Valley Idaho;

NAMI Virginia; NAMI Washington; NAMI York County; NASW Texas

Chapter; National Alliance on Mental Illness; National

Alliance on Mental Illness of Central Suffolk; National

Alliance on Mental Illness of Park County, WY; National

Association for Home Care & Hospice; National Association for

Uniformed Services; National Association of Hepatitis Task

Forces; National Association of Manufacturers; National

Association of Nutrition and Aging Services Programs

(NANASP); National Association of Social Workers--NC Chapter;

National Association of Social Workers--Virginia Chapter;

National Association of Spine Specialists; National Center

for Policy Analysis; National Coalition for LGBT Health.

National Council for Behavioral Health; National Council of

Asian Pacific Islander Physicians; National Fibromyalgia &

Chronic Pain Association; National Grange; National Hispanic

Medical Association; National Minority Quality Forum;

National Psoriasis Foundation; National Retail Federation;

National Rural Health Association; National Spasmodic

Torticollis Association; NCCEP North Carolina College of

Emergency Physicians; NC State Grange; Nebraska Medical

Association; Nebraska Rural Health Association; Nebraska

State Grange; Nebraska Taxpayers for Freedom; Neuro Network

Partners; Neurofibromatosis, Inc. Mid-Atlantic; Neurosurgical

Society of Kentucky; Nevada Academy of Ophthalmology.

Nevada Chapter ACEP; Nevada Health Care Association; Nevada

Orthopaedic Society; New England Biotech Association; New

Jersey Academy of Ophthalmology; New Jersey Association of

Mental Health and Addiction Agencies, Inc.; New Jersey

Chapter ACEP; New Jersey Mayors Committee on Life Science;

New Jersey Orthopaedic Society; New Jersey Rheumatology

Association; New Jersey State Nurses Association; New Mexico

Biotechnology & Biomedical Association (NMBio); New Mexico

Association of Nurse Anesthetists; New Mexico Chapter ACEP;

New Mexico Health Care Association; New Mexico Podiatric

Medical Association; New York ACEP; New York Regional Society

of Plastic Surgeons; New York State Neurological Society; New

York State Ophthalmological Society.

New York State Rheumatology Society; New York State Society

of Orthopaedic Surgeons, Inc.; New York State Society of

Plastic Surgeons, Inc; New York State Urological Society;

NHACEP; North American Neuro-Ophthalmology Society; North

Carolina Alliance for Retired Americans; North Carolina

Biosciences Organization; North Carolina Chamber; North

Carolina Foot & Ankle Society; North Carolina Psychological

Association; North Carolina Rheumatology Association; North

Carolina Society of Eye Physicians and Surgeons; North Dakota

Chapter ACEP; North Dakota Medical Association; North Dakota

Podiatric Medical Association; North Dakota Society of Eye

Physicians and Surgeons; North Macon Family Healthcare

Associates; Northeast Kidney Foundation; Northern Utah

Coalition, Inc.

Northwest Urological Society; Novartis Pharmaceuticals

Corporation; Occasional Riot; Ogden Branch of the NAACP; Ohio

ACEP; Ohio Association of County Behavioral Health

Authorities; Ohio Association of Medical Equipment Services;

Ohio Association of Rheumatology; Ohio Chamber of Commerce;

Ohio Council for Home Care and Hospice; Ohio Foot and Ankle

Medical Association; Ohio Jewish Communities;

Ohio Orthopaedic Society; Ohio Osteopathic Association;

Ohio State Grange; Ohio Veterans United; OKBio; Oklahoma

Academy of Ophthalmology; Oklahoma ACEP; Oklahoma Association

of Nurse Anesthetists.

Oklahoma Osteopathic Association; Oklahoma Podiatric

Medical Association, Inc.; Oklahoma Society of

Anesthesiologists; Oklahoma Society of Oral and Maxillofacial

Surgeons; Oklahoma State Medical Association; ONEgeneration;

Oregon Academy of Opthalmology; Oregon Chapter of American

College of Emergency Physicians; Oregon Medical Association;

Oregon Neurosurgical Society; Oregon Podiatric Medical

Association; Oregon Rheumatology Alliance; Oregon Society of

Anesthesiologists; Oregon Urological Society; Orthopaedic

Research Society; Orthopaedic Society of Oklahoma;

Orthopaedic Trauma Association; Osteopathic Physicians &

Surgeons of California; Pacific Northwest Chapter of TRIO; PA

Prostate Cancer Coalition.

Partnership to Fight Chronic Disease; PCa Blue Inc.;

Pediatric Orthopaedic Society of North America; Pennsylvania

Chamber of Business and Industry; Pennsylvania College of

Emergency Physicians; Pennsylvania Neurosurgical Society;

Pennsylvania State Grange; Perennial Services Network;

Pfizer; Pharmaceutical Care Management Association;

Philadelphia Rheumatism Society; PhRMA; Plaza Community

Services; Premier healthcare alliance; Prescription

Assistance Network of Stark County, Inc; Prevent Blindness

Iowa; Prevent Blindness, Ohio Affiliate; Progressive

Democrats of Central New Mexico; Progressive Leaders of

Louisiana; Prostate Health Education Network.

Radiology Associates of Macon; Rainy Day Patriots;

Respiratory Health Association; RetireSafe; Rheumatism

Society of the District of Columbia; Rheumatology Alliance of

Louisiana; Rheumatology Association of Iowa; Rheumatology

Association of Minnesota and the Dakotas; Rheumatology

Association of Nevada; Rheumatology Society of North Texas;

Rhode Island Chapter ACEP; Rhode Island Medical Society;

Rhode Island Society of Eye Physicians and Surgeons; Rhode

Island Tech Collective; Rio Grande Valley Diabetes

Association; RIPMA; Rocky Mountain Stroke Center; RTI

Surgical Inc.; Rush To Live; SAGE Utah.

Saint Agnes Healthcare; Salud U.S.A.; Sandhills Adult Day

Health Center, Inc.; San Diego County Podiatric Medical

Association; Sanofi US; SC Podiatric Medical Association

(SCPMA); Scoliosis Research Society; Sea Island Pediatrics;

Senior Connections, The Capital Area Agency on Aging; Seniors

Golden Hammer; Seniors Hospitality Center / Bonners Ferry

Senior Center; Sickle Cell Disease Association of Florida;

Sjogren's and Lupus Foundation of Hawaii; Sjogren's Syndrome

Foundation; Small Business & Entrepreneurship Council; Smile

Community Action Partnership; Society of Academic Urologists;

Society for Cardiovascular Angiography and Interventions;

Society for Vascular Surgery; Society of Military Orthopaedic

Surgeons.

Society of Urologic Oncology; Solidarity Project Advocacy

Center; South Carolina BIO; South Carolina Hospital

Association; South Carolina Medical Association; South

Carolina Medical Group Management Association (SCMGMA); South

Carolina Nurses Association; South Carolina Orthopaedic

Association; South Carolina Rheumatism Society; South

Carolina Society of Ophthalmology; South Carolina Urological

Association; South Dakota Biotech; South Dakota State Medical

Association; South Dakota State Orthopaedic Society; South

Florida Cancer Association; Southern Orthopaedic

Association; State Chamber of Oklahoma; State of Texas

Association of Rheumatologists; State of Texas Kidney

Foundation; Statewide Independent Living Council of

Hawaii.

StopAfib.org; Suicide Awareness Voices of Education;

Sunovion Pharmaceuticals Inc.; Survivors Cancer Action

Network; Takeda Pharmaceuticals, USA Inc.; TCEP Texas College

of Emergency Physicians; Tech Council of Maryland; Tennessee

Association of Long Term Care Physicians; Tennessee

Geriatrics Society; Tennessee Hemophilia and Bleeding

Disorders Foundation; Tennessee Medical Association;

Tennessee Orthopaedic Society; Tennessee Rheumatology

Society; Texas Association for Home Care and Hospice; Texas

Association of Business; Texas Association of Neurological

Surgeons; Texas BioAlliance; Texas Health Resources; Texas

Healthcare and Bioscience Institute; Texas Life-Sciences

Collaboration Center.

Texas Medical Association; Texas Neurological Society;

Texas Nurse Practitioners; Texas Orthopaedic Association;

Texas Osteopathic Medical Association; Texas Pain Society;

Texas Radiological Society; Texas State

Grange; The AIDS Institute; The Arc in Hawaii; The Arc of

Anchorage; The Benefits Consultancy; The Jewish Federations

of North America; The Macula Society; The Marilyn Fagan

Ovarian Cancer Patient Advocacy Program (ICAN-Hawaii); The

Meeting Group, Inc.; The Michael J. Fox Foundation for

Parkinson's Research; The National Association of Catholic

Nurses--U.S.A.; The National Catholic Bioethics Center; The

New England Council.

The New Mexico Association for Home and Hospice Care; The

Retina Society; The Surgery Center of Huntsville; The US

Oncology Network; The Vision Care Center; The Wall Las

Memorias Project; Twin Falls Senior Center; U.S. Chamber of

Commerce; U.S. Pain Foundation; Union Pacific Railroad

Employees Health Systems; Urban Pain Institute; Utah

Advocates; Utah Medical Association; Utah Podiatric Medical

Association; Utah Pride Center; Utah State Orthopedic

Society; Utah Support Advocates for Recovery Awareness;

Vermont Medical Society; Vermont State Association of

Osteopathic Physicians & Surgeons, Inc.; Veterans Health

Council; Vietnam Veterans of America.

Vietnamese Social Services of Minnesota; Virginia Bio;

Virginia Chamber of Commerce; Virginia Hispanic Chamber of

Commerce; Virginia Podiatric Medical Association; Virginia

Society of Eye Physicians and Surgeons; Visiting Nurse

Association; Visiting Nurse Association of Ohio; VITAS

Healthcare; Vizient, Inc.; Washington ACEP; Washington

Biotechnology & Biomedical Association; Washington

Rheumatology Alliance; Washington Rural Health Association;

Washington State Medical Association; Washington State

Orthopaedic Association; Washington State Podiatric Medical

Association; Washington State Prostate Cancer Coalition;

Washington State Urology Society; Wellness and Education

Community Action Health Network; Wellness Station.

West Virginia Academy of Eye Physicians & Surgeons; West

Virginia Academy of Otolaryngology--Head and Neck Surgery,

Inc.; West Virginia Orthopaedic Society; West Virginia State

Rheumatology Society; Western Orthopaedic Association;

Western Section of the American Urological Association;

Wisconsin Academy of Nutrition and Dietetics; Wisconsin

Academy of Ophthalmology; Wisconsin Association of

Osteopathic Physicians & Surgeons (WAOPS); Wisconsin Hospital

Association; Wisconsin Manufacturers & Commerce; Wisconsin

Medical Society; Wisconsin Rheumatology Association;

Wisconsin State Grange.

Wound Care Clinic--ESU; WPMA--Wisconsin Podiatric Medical

Association; Wyoming Chapter American College Emergency

Physicians; Wyoming Epilepsy Association; Wyoming Medical

Society; Wyoming Ophthalmological Society; ZERO--The End of

Prostate Cancer.

Mr. Speaker, let me just read one paragraph:

``IPAB, as constructed under PPACA, is a board comprised of Presidential appointees who will be charged with making recommendations to cut Medicare expenditures if spending growth reaches an arbitrary level. Once the Secretary of Health and Human Services implements an IPAB recommendation, that action is not subject to administrative or judicial review. As constructed, IPAB is granted unprecedented powers-- even the ability to change laws previously enacted by Congress--with virtually no oversight.'' Peter Orszag, President Obama's Office of Management and Budget Director, said it was the largest transfer of power from the legislative branch to a bureaucratic branch since the Federal Reserve, and that is a mouthful.

Democrats and Republicans may not always agree on how to get things done around here, but when you can bring 270 House Members together on one bill, it is pretty clear that something needs to be done immediately.

We were lucky this summer that the Medicare trustees report indicated that IPAB would not trigger until 2021 or 2022, but our back is against the wall and we must act. We cannot afford to let 15 unelected, unaccountable bureaucrats make decisions for our Nation's 58 million Medicare enrollees with no checks from Congress.

Mr. Speaker, I urge my colleagues to support this.

I refer also to a bipartisan letter I signed on December 17, 2009, that was written to the Speaker of the House at that time, Nancy Pelosi, which said the following:

``Finally, as the people's elected representatives, we must oppose any proposal to create a board that would surrender our legislative authority and responsibility for a Medicare program to unelected, unaccountable officials within the very same branch of government that is charged with implementing the Medicare policies that affect so many Americans.''

Mr. Speaker, I urge my colleagues to support this rule and support the final passage because that will show the American people you stand with America's seniors.

Mr. Speaker, I would like to include in the Record the following letter:

Congress of the United States,

Washington, DC, December 17, 2009.

Hon. Nancy Pelosi,

Speaker, House of Representatives,

Washington, DC.

Dear Madam Speaker: In July, 75 members of the U.S. House

of Representatives wrote to express strong opposition to

proposals, such as the ``Independent Medicare Advisory

Council (IMAC) Act of 2009'' and the ``Medicare Payment

Advisory Commission (MedPAC) Reform Act of 2009'' (H.R 2718,

S. 1110, S. 1380), that would divest Congress of its

authority for Medicare payment policy and place this

responsibility in an executive branch commission or board.

This letter clearly stated opposition to the inclusion of

these or any other similar proposals in health reform or any

other legislation, but with recent developments, we, the

undersigned members, believe it is imperative to restate our

strong opposition to any proposal or legislation that would

place authority for Medicare payment policy in an unelected,

executive branch commission or board.

Consistent with the July letter, on November 7, 2009, the

House passed the ``Affordable Health Care for America Act''

(H.R. 3962) did not include provisions to create an unelected

Medicare board. Yet, at present, the Senate is considering

the ``Patient Protection and Affordable Care Act of 2009,''

which includes provisions to create an ``Independent Medicare

Advisory Board'' (IMAB) that would effectively end Congress's

authority over Medicare payment policy.

To create an unelected, unaccountable Medicare commission

as envisioned in the Senate's IMAB proposal would end

Congress's ability to shape Medicare to provide the best

policies for beneficiaries in our communities around the

country. Through the legislative process, and from Medicare's

beginning, Members have been able to represent the needs of

their communities by improving benefits for seniors and the

disabled, affecting policies that fill the health care

workforce pipeline, and ensuring that hospitals are equipped

to care for diverse populations across our individual

districts. Such a responsibility is one that is not taken,

nor should be given away, lightly.

These proposals would severely limit Congressional

oversight of the Medicare program, and to place this

authority within the executive branch, without Congressional

oversight or judicial review, would eliminate the

transparency of Congressional hearings and debate. Without

the open and transparent legislative process, Medicare

beneficiaries and the range of providers who care for them

would be greatly limited in their ability to help develop and

implement new policies that improve the health care of our

nation's seniors. An executive branch Medicare board would

also effectively eliminate Congress's ability to work with

the Centers for Medicare and Medicaid Services to create and

implement demonstration and pilot projects designed to

evaluate new and advanced policies such as home care for the

elderly, the patient-centered medical home, new less invasive

surgical procedures, collaborative efforts between hospitals

and physicians, and programs designed to eliminate fraud and

abuse.

The creation of a Medicare board would also effectively

eliminate state and community input into the Medicare

program, removing the ability to develop and implement

policies expressly applicable to different patient

populations. Instead, national policies that would flow from

such a board would ignore the significant differences and

health care needs of states and communities. Geographic and

demographic variances that exist in our nation's health care

system and patient populations would be dangerously

disregarded. Furthermore, all providers in all states would

be required to comply even if these policies were detrimental

to the patients they serve. Such a commission could not only

threaten the ability of Medicare beneficiaries, but of all

Americans, to access the care they need.

Finally, as the people's elected representatives, we must

oppose any proposal to create a board that would surrender

our legislative authority and responsibility for the Medicare

program to unelected, unaccountable officials within the very

same branch of government that is charged with implementing

the Medicare policies that affect so many Americans.

Therefore, we must strongly oppose the creation of IMAB,

IMAC, a reconstituted MedPAC or any Medicare board or

commission that would undermine our ability to represent the

needs of the seniors and disabled in our own communities.

Again, we urge you to reject the inclusion of these or any

like proposal in health reform or any other legislation.

Sincerely,

Richard Neal, Gary Ackerman, Shelley Berkley, Brian

Bilbray, Tim Bishop, Marsha Blackburn, Mary Bono Mack, Ginny

Brown-Waite, Michael Burgess, G.K. Butterfield, Steve Buyer,

Kendrick Calvert, Michael Capuano, Russ Carnahan, Bill

Cassidy, Donna Christensen, Judy Chu, Yvette Clarke, William

Lacy Clay, Joe Courtney.

Joseph Crowley, Susan Davis, William Delahunt, Eliot Engel,

Sam Farr, Bob Filner, John Fleming, Barney Frank, Phil

Gingrey, Alan Grayson, Gene Green, Brett Guthrie, John Hall,

Maurice Hinchey, Mike Honda, Steve Israel, Hank Johnson,

Steve Kagen, John Lewis, Nita Lowey.

Steve Lynch, Daniel Maffei, Carolyn Maloney, Edward Markey,

Eric Massa, Doris Matsui, Jim McDermott, Jim McGovern, Jerry

McNerney, Kendrick Meek, Gregory Meeks, Jerrold Nadler, John

Olver, Bill Pascrell, Donald Payne, Laura Richardson, Phil

Roe, Mike Rogers, Dana Rohrabacher.

Bobby Rush, Linda Sanchez, Allyson Schwartz, Pete Sessions,

Pete Stark, Mike Thompson, Patrick Tiberi, John Tierney,

Edolphus Towns, Lynn Woolsey.

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 600 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentlewoman from New York (Ms. Slaughter), 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 600 provides for the consideration of a bipartisan bill reported by the House Ways and Means Committee and the Energy and Commerce Committee.

The rule provides for 1 hour of debate equally divided and controlled by the chairs and ranking members of the Committee on Energy and Commerce and the Committee on Ways and Means.

The rule adopts the amendment in the nature of a substitute recommended by the Committee on Ways and Means.

Further, the rule waives all points of order and makes in order no further amendments to the legislation. However, the minority is afforded the customary motion to recommit.

Mr. Speaker, on behalf of millions of seniors in my home State of Texas and all across the United States, I am grateful that the House is considering H.R. 849, the Protecting Seniors' Access to Medicare Act of 2017.

This bill has been championed by my good friend from Tennessee, Dr. Phil Roe, in this Congress and in previous

Congresses. It accomplishes a very simple task: To repeal the unpopular Independent Payment Advisory Board created under the Affordable Care Act.

This repeal has strong bipartisan support in both the Energy and Commerce Committee, on which I serve, and in this entire body.

As of today, there are 270 Republican and Democratic cosponsors to the bill who all agree that the creation of this board was a very bad idea.

More than 800 organizations representing every State support this bill. If I may add, this includes seniors, patient advocacy groups, physician groups, and other healthcare provider organizations.

This board is charged with broad, sweeping powers to reduce Medicare spending when Medicare spending exceeds an arbitrary target.

The board is a panel composed of 15 members appointed by the President, confirmed by the Senate for up to two consecutive 6-year terms. Fewer than half of the Independent Payment Advisory Board members can be healthcare providers, and no one--and this is an important point--on the board may receive outside income. So that means by its very definition that this board is comprised of people who cannot be practicing physicians.

The other members will come from the ranks of think tanks, unions, and academia.

For a panel with so much authority over Medicare spending, there could be little to no clinical expertise amongst the board members.

Is this what Americans really want?

Now, here is some good news. The board has yet to be formed. Hooray for that. According to the 2017 Annual Report on the Boards of Medicare Trustees from the Centers for Medicare and Medicaid Services' Office of the Actuary, the Independent Payment Advisory Board may not be formed until at least 2021, based on the current Medicare spending rate projections.

Well, that is good news to seniors and their doctors and their families, but these projections are just numbers and they can change. In fact, last year the projection was very different, that the Independent Payment Advisory Board would be triggered this year rather than the delay.

The concern of many of us here in the House and hundreds of stakeholders I have heard from is that under the law, the Independent Payment Advisory Board's proposals are required to be implemented by the Secretary of Health and Human Services unless Congress acts by creating its own proposal to achieve the exact same savings or by preventing the automatic implementation process as defined by law.

So what is that process?

The law mandates immediate introduction of legislation

encompassing the Independent Payment Advisory Board proposed

bills in Congress--

Stop and think about that for a minute. That is not a bill introduced by a Member of Congress. That is a bill introduced by an outside board. That is a bill introduced by the administration. Let me recapitulate.

The law mandates immediate introduction of legislation

encompassing the Independent Payment Advisory Board proposed

bills in Congress and establishes strict deadlines for

committee and Senate floor consideration, and places limits

on the appropriations process.

While Congress is permitted to modify the type of cuts to

Medicare, it must achieve identical savings amounts to

Medicare spending as contained in the board's plan. The law

bars Congress from changing the Independent Payment Advisory

Board fiscal targets in any other legislation it considers,

and it creates procedures whereby a super majority vote is

required in the Senate to waive this requirement.

If the Independent Payment Advisory Board fails to report

recommendations or never becomes operational, the Secretary

of the Department of Health and Human Services is given the

power to implement the cuts unilaterally.

Well, you might think that, then, of course this would be under judicial or administrative review, but the Independent Payment Advisory Board is exempt from administrative or judicial review.

No matter what your views are on the Affordable Care Act, we should all agree that giving this much power to a panel of unelected and unaccountable officials or a Cabinet Secretary, whoever he or she may be in any administration, giving away this much power is simply bad policy. The House shouldn't be for that.

This process is extremely complicated, and maybe that was the intent of the people who wrote the provision creating this board under the Affordable Care Act.

I also fundamentally believe that the Independent Payment Advisory Board infringes on the separation of powers by shifting authority from the legislative to the executive branch. Not only does the creation of this board significantly limit Congress' authority, it eliminates needed transparency from hearings and debate. It eliminates any meaningful opportunity for stakeholder input.

I believe leaving Medicare payment decisions in the hands of those who are unelected and unaccountable, with little congressional oversight, will actually harm seniors' access to quality healthcare.

Congress has played an integral role in shaping policies that best reflect the needs of our districts and our States, and our constituents demand that. That is the reason they sent us here.

Lastly, as a physician, I treasure the doctor-patient relationship. I believe we must do more to honor this relationship and prevent the Federal Government from further eroding this precious commodity.

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

Mr. Speaker, I yield 5 minutes to the gentleman from Tennessee (Mr. Roe), the chief sponsor of the bill.

Mr. Speaker, I yield 2 minutes to the gentleman from Florida (Mr. Dunn), who is also a physician.

Mr. Speaker, I yield myself 1\1/2\ minutes.

Mr. Speaker, I did want to delineate the membership of this board, as is outlined in the Affordable Care Act. The board will be appointed by the President with the advice and consent of the Senate, with the advice and consent of the Secretary or the Administrator of the Centers for Medicare and Medicaid Services, and the Administrator of the Health Resources and Services Administration. All of those individuals will serve as ex officio nonvoting members. But here are the qualifications for the actual board:

``The appointed membership of the board shall include individuals with national recognition for their expertise in health finance and economics, in actuarial science, health facility management, health plans, and integrated delivery systems, and reimbursement of healthcare facilities. . . .''

Missing from that picture, of course, are the people who actually provide the care to people who are involved in that doctor-patient relationship. Almost as an afterthought, here at the end of that paragraph, ``allopathic and osteopathic physicians.''

The other aspect is that no member of the board can receive outside income. That may be a good idea, but that guarantees there will not be a practicing physician on that board. I think that is a significant oversight.

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

Mr. Speaker, I yield 1 minute to the gentleman from Georgia (Mr. Carter).

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

I recall things a little differently. I recall the lie of the year being, if you like your doctor, you can keep your doctor, but I guess that is a debate for another day.

Mr. Speaker, today's rule provides for consideration of an important piece of legislation to protect seniors' access to healthcare from the ill-advised Medicare Independent Payment Advisory Board created by the Obama administration within the Affordable Care Act.

I thank the authors, Chairman Brady and Dr. Roe, and the 270 House cosponsors of H.R. 849 for their thoughtful and bipartisan legislation, and I urge my colleagues to support the rule providing for consideration of this underlying bill, and then support the bill.

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

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

Mr. Speaker, the Independent Payment Advisory Board was created, in fact, by the Affordable Care Act, as we have heard. It will be a 15- member panel composed of Presidentially appointed and Senate-confirmed experts charged with developing proposals to prevent Medicare costs from getting too high. It is about fiscal prudence.

The majority and its allies, however, spread many mistruths about the board. It has even been called a death panel, if you remember that. In reality, nothing could be further from the truth. Its recommendations may not increase cost-sharing premiums or taxes, or reduce benefits. They have no way to do that.

Not a single soul has been nominated to the board. It is not yet instituted as an entity. Today, in the absence of an appointed board, the Secretary of Health and Human Services is directed to submit recommendations to Congress if a trigger is met.

The independent Medicare actuaries predict that this board will not be triggered until at least 2021, 4 years from now.

Mr. Speaker, I think we have to ask: Why are we spending time today, with everything facing us, addressing a problem that could exist 4 years from now? Is the majority so desperate to undermine the Affordable Care Act that they are repealing a panel whose sole purpose is keeping Medicare costs in line?

According to Gallup, 55 percent of the public approves of the healthcare law. They want to see it strengthened, not eviscerated.

In contrast, under the majority's leadership, Congress has an approval rating of just 13 percent.

Should 13 percent be telling 55 percent what they need to do?

Instead, since the majority has so far been unable to repeal it, they are going to undermine it brick by brick. The President is even sabotaging the Affordable Care Act administratively, slashing the budget to publicize the law by 90 percent, and cutting the open enrollment period in half.

In the interest of public service, let me say that the enrollment period started yesterday and continues to December 15. Please go and take care of your health insurance.

What the White House has done is make a direct attempt to cause chaos to weaken signups under the open enrollment period that began this week.

The Kaiser Family Foundation estimated that, as a result of the Affordable Care Act, Medicare growth has been historically low. The growth in healthcare prices is at its lowest level in 50 years. The nonpartisan Congressional Budget Office projected that Medicare growth rates will remain beneath this panel's targets until 2021, hence the reason for not doing a panel for 4 more years.

It is really too bad that this Congress and the majority insist on sabotaging

the Affordable Care Act, chipping away at its benefits. We should be strengthening it. Remember that every President since Theodore Roosevelt just about has tried to do a healthcare bill like the one that we have today. Perhaps just because Barack Obama did it that there is so much problem with it in the majority.

There is a bipartisan Senate bill crafted by Senator Alexander and Senator Patty Murray that the nonpartisan Congressional Budget Office found last week would save money, stabilize the insurance marketplace, and reduce the debt by $3.8 billion. That is all without anyone losing their insurance.

Why won't we take up that bill?

We never get an answer for that question.

What is it about trying to take healthcare away from poor people or that we won't put a bill on the floor that has all the advantages and savings that we know and that is totally bipartisan? Is it because the majority knows it will pass?

Our Nation has urgent problems. Our infrastructure is crumbling, education costs skyrocket so high so fast that it is unattainable to many students. We desperately need to stabilize our health insurance markets by passing the compromise by Senators Alexander and Murray. That is what we should be doing here today.

There are Members on both sides of the aisle who want to see improvements to the board, but that is not what the bill does. It terminates it altogether. It is the wrong approach at definitely the wrong time.

Regardless of what you think about this board, we should be able to agree that this Congress has more important things to do than address a problem that might not exist for 4 years, if at all.

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

Mr. Speaker, I yield myself 1 minute.

Mr. Speaker, I am very troubled by this. I don't want to insult my learned colleagues, but it plainly says in the legislation that IPAB cannot ration healthcare, cannot raise taxes or increase deductibles and copayments. Under the current law, section 1899A, 42 U.S.C. clearly states: ``The proposal shall not include any recommendation to ration healthcare; raise revenues or Medicare beneficiary premiums; increase the cost sharing, including deductibles, coinsurance, and copayments; or otherwise restrict benefits or modify eligibility criteria.''

I regret I have to do that, because it is a direct contradiction of what my good friends on the other side have told the country and what I assume that they believe.

Mr. Speaker, Russia interfered with our 2016 election. That much is clear from special counsel Mueller's investigation, which led to indictments against two Trump campaign aides. The legitimacy of our electoral system is at stake, and it is time the Republican-controlled Congress sets aside the partisan politics and treats this threat with the gravity it deserves.

If we defeat the previous question, I will offer an amendment to the rule to bring up Representative Swalwell and Representative Cummings' bill, which would create a bipartisan commission to investigate the Russian interference in the 2016 election.

Mr. 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.

Mr. Speaker, one of the worst political stories I have heard in my lifetime is what we just talked about, the ``death panel,'' what it is going to do, even though it is prohibited by the written law to do the things that it has been accused of being able to do. Most of that, PolitiFact talked about the death panel part of it and said that that was the 2009 lie of the year. But here we are, 8 years later, and we keep hearing mistruths about the panel and its intent. The board is about keeping Medicare growth in line, nothing more, nothing less.

So let's be honest about what the bill really is about: attacking the Affordable Care Act. Regardless of what you think about the Independent Payment Advisory Board, the Nation has immediate problems today that deserve our attention, from healthcare to education, to infrastructure.

We should not be taking this valuable House time talking about a board that may or may not come into existence 4 years from now. That is not what we need to deal with today. So I urge a ``no'' vote on the previous question and the rule.

I reserve the balance of my time.

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

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

Mr. Speaker, I yield 3 minutes to the gentleman from California (Mr. Ruiz).

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

Mr. Speaker, I rise in opposition to H.R. 849, the IPAB repeal.

Mr. Speaker, Republicans have spent the last 9 months trying to repeal the Affordable Care Act and they have failed, but instead of working with Democrats to improve the ACA, they will stop at nothing to repeal the law piece by piece.

The Republicans' partisan bill to reauthorize CHIP, community health centers, and other public health extenders is paid for on the back of Medicaid recipients, Medicare, low- and middle-income families with the Affordable Care Act health coverage, and the Prevention Fund, but yet they will not bother to pay for the $17.5 billion it will cost to repeal IPAB.

IPAB was enacted as a backstop to the other cost-saving and quality- improvement efforts in the ACA, such as accountable care organizations, patient-centered care models like Medical Homes, programs that pay for quality, not quantity and value-based purchasing.

Because of the Affordable Care Act and these programs, Medicare spending growth has slowed and Medicare solvency has been extended.

According to the CMS actuary, IPAB will not be triggered until 2021, so the

timing of today's repeal is premature and politically motivated.

IPAB repeal would increase the deficit by $17.5 billion. This is fiscally irresponsible of Republicans, especially as they prepare to announce a tax package that will saddle our country with $1.5 trillion of debt in order to give tax cuts to the wealthy and corporations.

IPAB repeal is not about helping seniors. Don't let the Republicans kid you. Contrary to what the Republicans say, IPAB is prohibited from sending recommendations to Congress that would harm seniors by increasing their out-of-pocket costs or cutting their benefits. In fact, it is the Republican ACA repeal efforts that would cut nearly a trillion dollars from Medicaid and Medicare, harming seniors and other vulnerable Americans, which would have truly led to the rationing of healthcare.

So for all these reasons, I urge my colleagues to vote ``no'' on H.R. 849, the IPAB repeal.

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

Mr. Speaker, I yield 4 minutes to the gentleman from Vermont (Mr. Welch), a member of our committee.

Mr. Speaker, I yield an additional 2 minutes to the gentleman from Vermont.

Mr. Speaker, may I inquire as to how much time remains?

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

Mr. Speaker, I can't help but put what is happening today in terms of the Republicans putting up this bill on the IPAB and what is happening tomorrow with the Republicans putting up a CHIP and community health centers bill but point out that collectively what they are trying to do is what they were not able to do in the first 9 months of this session when they sought very hard and pushed very hard to repeal the Affordable Care Act.

What is going on here today and tomorrow with the IPAB and community health centers and CHIP is essentially an effort to repeal the Affordable Care Act piece by piece, in my opinion.

What do we do?

We see the IPAB, which is part of the Affordable Care Act. We see the pay-fors for community health centers and the CHIP tomorrow, taking away money from the Prevention Fund from the Affordable Care Act, limiting the grace period when people will lose their insurance that they have under the Affordable Care Act.

This goes along also with what is happening with the President as well. The President has, in the last month or so, said that he is not going to pay the cost-sharing subsidies. He has cut back on the outreach so that people don't know what is in the Affordable Care Act. He has cut back on the period when people can sign up and get their insurance in half.

What we are seeing, in my opinion, is the Republicans sabotaging the Affordable Care Act. They couldn't repeal it, so now they are doing whatever they can to sabotage it. It is really ironic or inconsistent, however you want to put it. On the one hand they are insisting that when it comes to kids and community health centers, which is a group of people you would think they would be most concerned about, they insist on paying for it by taking money from other healthcare programs. We are asked to take money from the Prevention Fund, which pays for vaccines for children, which pays for the children's lead poisoning program, which is a major part of our opiate prevention program. This is the money that comes from the Prevention Fund. Basically, they are taking that money and using it to pay for the community health centers and the Children's Health Initiative, which means that that money is lost. That money is lost for those other purposes.

With regard to the grace period, they are saying, well, if you fail to pay your insurance, it used to be 90 days before you lost it. Now it would be 30 days before you lost it, which means that you end up with about 500,000 or 600,000 people who have insurance now under the Affordable Care Act that would lose it, according to the CBO.

Yet, at the same time, with the IPAB repeal, which we are considering now, which costs $17.5 billion, and which, as my colleague from Vermont said, is a mechanism to try to save costs, they are saying: Well, we don't have to pay for that. We can just repeal it. We will forego those additional costs, which become part of the deficit.

Mr. Speaker, for all these reasons, the bottom line is, what the Republicans are doing is not fair. It is not fair to the kids. It is not fair to the people who are going to lose their health insurance.

I will say as the last thing that this is going nowhere. One of the reasons why Democrats have been urging the Republicans with regard to the CHIP and community health centers to work with us on a bipartisan basis is because we know if this bill passes today on a partisan vote, because we can't support it for the reasons I explained, then that means that it is going to go to the Senate and it is going to die because there is no reason to believe that the Senate is going to take up this partisan bill.

I think it is just a huge mistake on the part of Republicans. Basically, what they are signaling today is that they don't really care about this. They wanted to stick around until the end of year, which means the community health centers and CHIP just basically wither on the vine for lack of funds. That is not fair. It is not fair to the kids. It is not fair to those who use community health centers.

Mr. Speaker, for all these reasons, I would urge a ``no'' vote on the bill today, the IPAB repeal; and I will also ask for a ``no'' vote tomorrow on the CHIP and the community health centers legislation.

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

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

Mr. Speaker, I thank my friend for yielding me this time.

Mr. Speaker, I rise today in opposition of the repeal of the Independent Payment Advisory Board.

This is another classic example of a solution in search of a problem. Of all the things that we should be working on in Congress in a bipartisan fashion to improve and to fix the problems that exist within our healthcare system, we have legislation on the floor before us today that calls for the repeal of a nonexisting commission, based on nonconsistent spending cuts being proposed for Medicare, based on a nonconsistent cost of rate of increase in spending under the Medicare program, all of which is going to add $17.5 billion to the deficit over the next 10 years because this bill isn't paid for. And the irony is they are coming forward with this legislation, which will add another $18 billion to the debt, on the same day they release a tax bill that calls for an additional $1.5 trillion worth of deficit spending because the tax bill hasn't been offset. At some point and at some time, we have got to take a bipartisan stand on fiscal responsibility in this place again because it is not happening today.

Instead, we should be working on short-term, practical solutions to stabilize and bring more certainty to the health insurance marketplace, in light of what the administration is doing to completely undermine the marketplaces today. We ought to be working on delivery system reform proposals that will emphasize the establishment of accountable care organizations and medical homes and value-based purchasing and bundling arrangements and different alternative payment models to get us to a system of value, quality, and outcomes, and away from the fee- for-service payment for the volume of services, regardless of results.

Let's be honest, the real cost driver in our Federal budget--and it is true at the State and local level--has been healthcare costs because we have an aging population. That is the work that we should be working on together, is the delivery system reform and the payment reform, so we are aligning the incentives in the right direction where we are telling our healthcare providers: You will be compensated based on good results, not on how much you do.

There is a lot within the Affordable Care Act giving our providers the very tools in order to accomplish that, and we ought to be enhancing that here today. Instead, we are wasting time on a commission that, according to the CMS's own actuary, says, at the very earliest, it might be comprised in 2021. But, even then, it warrants us, with the mission that we have given it, that: Hey, you have got healthcare spending within the healthcare system that, Congress, you need to deal with. And then come back with recommendations. And then it is up to us to make corrective action at that time.

So all this talk about unelected bureaucrats making these decisions belies what the legislation actually calls for in the establishment of the IPAB. This was, however, another important cost containment tool that was put into the Affordable Care Act to try to restrain the growth of healthcare spending. We need more of those type of ideas, rather than efforts today to remove those tools and then possibly see just unbridled healthcare spending in the future.

What is really disturbing is I know there is a lot of common ground in this area, yet the American people wouldn't know it, with this political ping-pong ball on healthcare reform going back and forth and the chaos and the confusion that it is causing, and that is unfortunate.

So, instead, today, we ought to first take steps to stabilize the insurance exchanges, rather than an administration that is doing everything they can to limit the enrollment during the signup period, which actually started yesterday and lasts until December 15. They have cut by 90 percent funding for marketing of the exchanges. They have cut by almost 50 percent the funding for our navigators back home who are trying to help people get affordable healthcare coverage in their lives. They ended the cost-share payments, which only increases the cost for healthcare for everyone else because of the risk that the insurance plans now face.

The other segment of the population that we should be focused on in helping is that 5 or 6 percent of the population that are in the individual market who don't qualify for premium tax credits because they are getting hammered today. You would think that would be another area of bipartisan commonality that we can come together on

to provide relief for those individuals who are in the individual market experiencing these higher premiums, part of it being done because of the elimination of the cost-sharing reduction payments, but, instead, nothing is being done on that front.

My friend from Michigan also pointed out that we should be having hearings about the cost of prescription drugs in committee. That is one of the main cost drivers within the healthcare system, yet there is deafening silence in the Halls of Congress when it comes to taking measure on that front, even though President Trump promised during the course of his campaign and even earlier this year to try to take some action in a bipartisan way to address drug costs.

It was an initiative that the President was even interested in trying to address. Yet, again, nothing is being done.

So this legislation is much ado about nothing because there is nothing pending. In fact, nothing would be pending, according to the CMS actuary, until, at the earliest, 2021. Instead, we are wasting time and opportunity to address the real problems and finding the real fixes that are needed in the healthcare system. There I am confident there is a lot of bipartisan overlap, having worked with many of my colleagues on the committee and across the aisle, on many of these measures that I just mentioned here today.

So I encourage my colleagues to vote ``no'' and allow this to go forward, because it does keep an eye on rising costs and it keeps the pressure where it belongs--right here in Congress--to take future action if the rate of growth starts spinning out of control.