Floor Statements

Madam Speaker, I move that the House do now adjourn.

The motion was agreed to; accordingly (at 1 o'clock and 54 minutes p.m.), under its previous order, the House adjourned until tomorrow, Friday, July 27, 2018, at 10 a.m.

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 1011 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentleman from Florida (Mr. Hastings), pending which I yield myself 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 1011 provides for the consideration of two bills aimed at removing some of the most burdensome aspects of the Affordable Care Act, and, as a result, moving toward lowering healthcare costs for the millions of Americans who are confronted daily with rising premiums, rising deductibles, and rising drug prices.

With each bill, we take one step closer to ultimately eliminating the Affordable Care Act's government-run approach to healthcare and return to a market-driven solution that puts patients first.

The first bill in today's rule, H.R. 184, the Protect Medical Innovation Act of 2017, would repeal the excise tax on medical devices imposed on American companies by the previously mentioned Affordable Care Act.

The second bill in today's rule, H.R. 6311, the Increasing Access to Lower Premium Plans and Expanding Health

Savings Accounts Act of 2018, expands the availability and the use of health savings accounts to allow individuals and their families to save their own money and budget for the healthcare needs they have that otherwise would not be part of their budget.

Today's resolution provides for a closed rule for H.R. 184, the Protect Medical Innovation Act of 2017. This is the standard practice for a tax-related measure on the House floor. The rule provides for 1 hour of debate, equally divided and controlled by the chair and the ranking minority member on the Committee on Ways and Means. The rule does provide the minority with the customary motion to recommit with or without instructions.

The second part of today's resolution provides for a closed rule for H.R. 6311, the Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act of 2018. The rule provides for 1 hour of debate equally divided and controlled by the chair and the ranking minority member of the Committee on Ways and Means. The customary motion to recommit with or without instructions is provided to the minority.

This week, Republicans in the House continue our efforts to increase more healthcare options while driving down premiums in the individual market. According to the Office of the Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services, premiums on the exchange are 105 percent higher, on average, in calendar year 2017, compared to premiums in the individual market in calendar year 2013, which was the last year before the Affordable Care Act took effect.

It is important that we continue to address the negative impact that the Affordable Care Act has had on the individual market and to help Americans across the country be more in charge of their healthcare purchases.

Thus far, the Republican Congress has been successful in nullifying the individual mandate, repealing the Independent Payment Advisory Board, and delaying many of the harmful taxes on American businesses and American consumers. I am also encouraged by the actions of the administration in permitting more low-cost limited duration insurance plans and allowing access to association health plans for more small businesses.

These are choices that are provided to the American people so that they, the American people, can be in the driver's seat, not the other way around with the ACA's government-approved one-size-fits-all healthcare model.

With that in mind, two bills we are considering this week seek to expand and improve health savings accounts. Under the current rule, H.R. 6311, the Increasing Access to Lower Premium Plan and Expanding Health Savings Accounts Act of 2018, will enhance the benefit of tax- preferred health accounts so that individuals can better plan and save for their healthcare needs, and, also, these individuals will see lower premiums on their healthcare plans.

For the last several Congresses, I have argued to improve the utility of health savings accounts, and so I am pleased to see that these important policies are being advanced through the House this week.

In addition to offering health insurance, many employers often arrange to reimburse their employees and their dependants some of their medical expenses that are not covered by health insurance. Health flexible spending accounts and health reimbursement arrangements are two of the more common arrangements offered by employers.

I have heard the frustration of employees, many of whom are my constituents in north Texas, over forfeiting the remaining amounts in their flexible spending account at the end of each plan year. We can all agree that the healthcare needs and purchases vary from year to year, where one year a person may have more medical expenses than the next or the other way around.

One of the provisions in H.R. 6311 eliminates the arbitrary ``use it or lose it'' rule and allows flexible spending account balances to be carried over to the next plan year within a reasonable annual flexible spending account contribution limit.

Another provision allows working seniors that are covered under an HSA-eligible high deductible health plan and enrolled in Medicare part A to continue to contribute to their health savings account. Just because someone becomes eligible for Medicare because of age, they should not be prohibited from continuing to contribute to a health savings account.

Under current law, there are annual health savings account contribution limits. In 2018, the limit for an individual was $3,450. For families, that amount was $6,900. While these limits are updated annually for inflation, they are significantly less than the combined limit on annual out-of-pocket deductible expenses.

H.R. 6311 would allow individuals to increase their contributions to equal to the combined annual limit on the out-of-pocket and deductible expenses under their HSA-qualified insurance plan. That would be $6,550 for an individual and $13,300 for a family this year.

The Affordable Care Act limits the option of individuals enrolled in bronze and so-called copper, or catastrophic, plans to make HSA contributions. Also, only those under 30 or those that qualify for a hardship exemption are actually able to purchase the so-called copper health plan. That is a 50 percent actuarial value health plan.

So, today, I am pleased that a bill that I introduced with Representative Roskam, H.R. 6314, the Health Savings Act of 2018, to expand the eligibility and the access to health savings accounts by allowing plans categorized as catastrophic and bronze plans in the individual and small group markets to qualify for HSA contributions. That is included in this bill.

Lastly, I appreciate working with the Ways and Means Health Subcommittee Chairman Peter Roskam on H.R. 6311. One of the key provisions of the bill is to provide an off-ramp from ObamaCare's rising premiums and limited choices by allowing the premium tax credit to be used for qualified plans offered outside of the law's exchanges and healthcare.gov.

In addition, it expands access to the lowest premium plans available, so-called copper or catastrophic plans, for all individuals purchasing coverage in the individual market and allows the premium tax credit to be used to offset the cost of such plans.

I recognize not everyone will choose to have a health savings account, but they should have the option because HSAs represent a powerful tool to lower prices and improve access to quality care for everyone, and those are goals that we can all share.

Now, it is well documented that many of the provisions contained within the Affordable Care Act have negative consequences on patients, both in access to care and in affordability. One of the provisions that has been universally criticized is that, on a large, bipartisan nature, its repeal was called for almost immediately after the passage of the Affordable Care Act. This is the tax on medical device manufacturers, or more commonly referred to as the medical device tax.

It seems illogical that within a piece of legislation that was purported to make medical care available, more accessible to all Americans, the Federal Government would want to tax the very providers of medical innovation that create devices to improve the delivery of healthcare, but, nevertheless, that is exactly what happened when ObamaCare passed in 2010, and it was done as a means to pay for the astronomical price tag that accompanied the Affordable Care Act.

This tax burden is unfair, and it actually increases costs that consumers pay at their doctors' offices. The tax has also been cited by dozens of medical device manufacturers who have or are considering moving their operations overseas so that they can continue to innovate without the heavy burden of this tax stifling their growth. This tax slows the creation of new techniques and devices, which will make the delivery of medicine more efficient, and it puts at risk the jobs that were created by the creation of such devices.

For anyone who thinks that we are merely talking about the largest and most expensive pieces of technology found within a hospital-- basically, your MRI, CAT scans, and some surgical equipment--let's be clear that

this tax covers every piece of medical equipment, from those large machines to the smallest of items, including syringes used to deliver lifesaving antibiotics and vaccines. It continues to negatively impact a number of constituents in my district and, I am certain, in districts around the country, and it does continue to create a burden on a number of companies.

The medical device tax has led to the elimination of thousands of good-paying jobs, and repealing it would be the first step to bringing those jobs back and stem the loss of future jobs within this vital industry that is helping to mitigate rising costs of healthcare due to the burdensome provisions within the Affordable Care Act.

This is a tax on business, a tax on consumers, and a tax on innovation. To date, 33,000 jobs have been lost in the medical device industry since the passage of the Affordable Care Act, and it is projected that over 130,000 additional jobs are on the chopping block.

Why would anyone be surprised about this? Excise taxes--and that is what this is, an excise tax--are meant to lead to a reduction in the consumption of the goods being taxed. We place an excise tax on cigarettes. We want to discourage people from smoking. We make it burdensome to afford a smoking habit.

Did we really intend, with the passage of the Affordable Care Act by congressional Democrats in 2010, to make it more burdensome to use more efficient medical devices?

H.R. 184 has bipartisan, bicameral support, with currently 277 cosponsors. Republican leadership in the House has heard this request and heard the calls from many Members within this body and is moving this bill in a responsible way to put Americans back to work and lower healthcare costs for all.

Mr. Speaker, I urge my colleagues to support today's rule and the underlying bill, and I reserve the balance of my time.

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

The gentleman is quite correct in identifying the other body as sometimes an obstacle to good public policy, for it was 1 year ago that the other body blocked a health care reform that this body had passed the previous May.

But, Mr. Speaker, I want to draw the House's attention to an article in today's Wall Street Journal. The title of the article is ``TrumpCare beats ObamaCare.'' And I just want to quote a little bit from this article.

To set the stage, in December, with the repeal of the individual mandate, and quoting here: ``But while many people didn't realize it at the time, it turns out that Mr. Trump has been helping to improve an important source of insurance coverage since virtually the moment he took office.''

Continuing to quote here: ``By prioritizing economic growth and reducing the tax and regulatory burdens on U.S. business, Mr. Trump has helped create an economy with more job openings than ever before. As if by magic, the invisible hand of a freer marketplace is now generating new benefits as employers compete to fill all those open positions.''

Continuing to quote here: ``For the first time in six years, the share of U.S. workers offered health insurance through their employer has risen, a sign a tighter labor market is prompting businesses to offer more generous benefits.''

So, Mr. Speaker, I simply submit that the activities of the Trump administration have, indeed, improved the healthcare landscape in this country. That is something we should acknowledge and embrace.

I reserve the balance of my time.

Mr. Speaker, I am prepared to close as well.

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

The gentleman from Florida is making a point about open rules, and I do feel obligated to point out in the 111th Congress--that was the Congress that was the first 2 years of President Obama's administration--in the 111th Congress, under Speaker Pelosi, the majority had zero open rules. That is zero open rules in the 2 years in which we saw the passage of the Affordable Care Act, the passage of Dodd-Frank; the House-passed Waxman/Markey, which was a cap-and-trade global warming bill, so significant pieces of legislation passed the floor of this House, all under closed rules.

But, Mr. Speaker, today's rule brings forward two pieces of legislation that will have a meaningful impact on Americans' healthcare costs, including the premiums and the prices they pay for medicines.

H.R. 184, the Protect Medical Innovation Act of 2017, which will repeal the Affordable Care Act's ill-conceived medical device tax, and H.R. 6311, the Increasing Access to Lower Premium Plans and Expanding Health Savings Account Act of 2018, which will provide greater freedom for Americans to use their own money to pay for medical expenses out of their health savings accounts, both of these build on the House's work over the past 2 years to make healthcare a more patient-centered market.

Mr. Speaker, I certainly want to thank Representatives Paulsen and Roskam for their work on these measures. I urge my colleagues to support today's rule and move the debate forward on this legislation.

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

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 1012 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentlewoman from California (Mrs. Torres), 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 1012 provides for the consideration of an important bill to return control of healthcare spending and budgeting back where it belongs: with the patient.

H.R. 6199, the Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018, would amend the Internal Revenue Code of 1986 to include certain over-the-counter medical products as qualified medical expenses for the purposes of spending one's own dollars within a health savings account.

Today's resolution provides for a rule to allow H.R. 6199, the Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018, the standard practice for a tax-related measure on the House floor. The rule provides for 1 hour of debate equally divided and controlled between the chair and the ranking minority member of the Committee on Ways and Means. The rule does, however, provide the minority with the customary motion to recommit with or without instructions.

Also included in the resolution before us today are the standard provisions allowing the House of Representatives to continue to operate while Members are home, working with their constituents during the August district work period.

Mr. Speaker, I rise today to speak in support of the rule on H.R. 6199, the Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018. This rule includes the work of various Members of Congress on the important issue of modernizing health savings accounts. While this legislation did not move through the Health Subcommittee of the Energy and Commerce Committee, my fellow members on the other Health Subcommittee, that of the Ways and Means Committee, have done quality work in moving this package. Each bill was reported favorably out of the Ways and Means Committee.

Mr. Speaker, I have long been a supporter of increasing flexibility within our healthcare system, especially through the use of health savings accounts. Health savings accounts allow patients to feel more involved and to have more control over their healthcare spending. As someone who has personally had a health savings account in the past, I believe it to be a powerful tool but that qualified expenses have been limited for too long.

This package will give more power to consumers by allowing them to use their hard-earned savings that they put into their health savings accounts on an expanded number of healthcare goods and services.

The first bill in this package, Promoting High-Value Healthcare Through Flexibility for High-Deductible Health Plans Act, introduced by Chairman Roskam, allows for first-dollar coverage flexibility for high- deductible health plans. Many individuals, especially in the post- Affordable Care Act world, have chosen to purchase high-deductible health plans. While this is a reasonable choice for many consumers, there are some who are faced with high out-of-pocket costs.

H.R. 6199 allows health plans to provide coverage for up to $250 per year for individuals or $500 per year for families before they meet their deductible. The goal of this provision is to incentivize services that could reduce future healthcare costs, such as primary care visits and telehealth services.

Additionally, under current law, individuals are unable to contribute to an HSA if they participate in a direct primary care service arrangement. Representative Erik Paulsen's Primary Care Enhancement Act, which is included in this rule, enables patients to be able to participate in a direct primary care service arrangement and remain qualified to contribute to a health savings account. It also includes direct primary care service arrangement fees as medical expenses.

Some individuals are fortunate enough to receive certain healthcare services at or nearby their workplace through their employer. Representative Mike Kelly's bipartisan Health

Savings Account Improvement Act of 2018, which is included in this package, addresses this issue.

While it is convenient and helpful to have access to such services, these individuals should not be barred from having a health savings account. This package creates a special rule that individuals can receive free or discounted services offered by their employers onsite or at retail medical clinics. These services may include physical exams, immunizations, nonprescription drugs, treatment of employment- related injuries, drug testing if required as a condition of employment, hearing or vision screenings, or other services that are not considered significant benefits in the nature of medical care.

Mr. Speaker, the post-Affordable Care Act world is riddled with flaws, but one of the biggest problems is its failure to promote consumer-driven healthcare. Expanding the use of health savings accounts could go a long way to reverse this trend. Health savings accounts give consumers incentives to manage their own healthcare costs by coupling a tax-favored savings account used to pay medical expenses with a high-deductible health plan that meets certain requirements for deductibles and out-of-pocket expense limits. The funds in a health savings account are owned by the individual and may be rolled over from year to year.

Health savings accounts are not a novel idea. They have been around since 2004, but current health savings account policy is extraordinarily restrictive, making it harder for consumers to take advantage of it.

I have spent several years in developing extensive reforms to increase the potential for health savings accounts for consumers, and H.R. 6199 includes meaningful improvements that we can, in fact, get across the finish line now to help families now.

One of these improvements is the ability for spouses to contribute to a health savings account under certain circumstances even if their spouse has a flexible spending account. Under current law, one spouse can reimburse expenses for their spouses' and other dependents' medical expenses; therefore, the other spouse is considered to be ineligible for an HSA.

This provision enables the spouse without the flexible spending account to reimburse for medical expenses, with certain restrictions. This is critical, as it gives individuals increased flexibility to save for their own healthcare expenses that a shared flexible spending account for the whole family may not provide.

Additionally, this bill allows for individuals to terminate or convert their flexible spending account and health reimbursement accounts into a health savings account under certain circumstances. Employers would be able to allow their employees to convert their flexible spending account and health reimbursement account balances into health savings account funds if they enroll in a high-deductible health plan with an HSA. This is critical in empowering patients and allowing them the flexibility to change health plans without losing their savings.

There is a dollar limitation of $2,650 for conversions for individuals, $5,300 for families, and the funds transferred into the HSA would count toward the enrollee's HSA contribution for that taxable year.

H.R. 6199, the bill introduced by Representative Lynn Jenkins from Kansas, makes commonsense, patient-centered reforms to help defray costs for individuals. Over-the-counter medications, allergy and cold medicines, antibiotic ointment, and pain relievers are historically ineligible expenditures for HSA and other tax-favored healthcare accounts. The ACA created a requirement in Federal law that forced account holders to go to their doctor to obtain a prescription for over-the-counter medications before purchasing them with their health savings account or flexible spending account. Individuals who fail to jump through these hoops and purchase over-the-counter medications without a prescription, in fact, face a tax penalty for making a nonqualified distribution.

This policy drives unnecessary utilization of doctor services, decreases access to over-the-counter medications, and discourages people from taking control of saving for their healthcare needs. H.R. 6199 repeals this harmful provision, puts consumers back in the driver's seat, and allows them efficient access to appropriate medications.

Lastly, this legislation permits individuals to invest their hard- earned health savings account dollars into their physical fitness and well-being. In many ways, income is a hurdle for individuals and families who would like to participate in a physical activity, whether they would like to pay for a membership at a fitness facility or pay for their children to join a youth sports league. This legislation opens the door for paying for such activities with health savings account dollars.

Known originally as a standalone bill, the Personal Health Investment Today Act, introduced by Representative Jason Smith, allows qualified sports and fitness expenses to count as qualified medical expenses. These particular expenses are capped at $500 a year for individuals and $1,000 on a joint return.

Passage of this provision will assist individuals and families across the Nation in investing in their physical fitness, which can lead them to healthier lives and stave off conditions such as diabetes and obesity. These bills are an important example of the work we are doing right now to advance Member-driven solutions that will improve healthcare for all Americans.

Deductibles, out-of-pocket limitations have been steadily growing. Congress should be taking steps to make it easier for Americans to save, not restricting their options. The rule and the underlying bills included in this package strengthen consumer power and increase flexibility for patients in paying for their medical expenses.

I appreciate all of the work that the Members have put into the provisions of this bill. I urge my colleagues to support today's rule and the underlying legislation, and I reserve the balance of my time.

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

Mr. Speaker, once again, I want to draw attention to an opinion article in today's Wall Street Journal. The title of the article is ``TrumpCare Beats ObamaCare,'' July 23, 2018, penned by James Freeman.

``By prioritizing economic growth and reducing the tax and regulatory burdens on U.S. business, Mr. Trump has helped to create an economy with more job openings than ever before. As if by magic, the invisible hand of a freer marketplace is now generating new benefits as employers compete to fill all those open positions.''

``For the first time in 6 years, the share of U.S. workers offered health insurance through their employer has risen, a sign a tighter labor market is prompting businesses to offer more generous benefits. . . .''

``The Trump plan is repairing at least some of the damage caused by ObamaCare. Notes the Journal:

``Among all private-sector workers offered medical benefits, 72 percent opted to take them,'' which is up from the 17 percent in 2010 when it began to decline.

Again, Mr. Speaker, this is to point out that this is all occurring without a new government program. This is because of the strength of the economy. This is what happens when you put the focus on creating good jobs for American workers. This is the benefit that results.

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

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

Mr. Speaker, I was serving in the United States House of Representatives when the congressional Democrats passed the Affordable Care Act. I was serving in the House of Representatives when the implementation of ObamaCare happened at the end of calendar year 2013.

I have got to tell you something. The President told me I had a junk insurance plan. I was covered by a health savings account in those years. Then-President Obama told me I had a junk insurance plan and that I was going to get something better.

I have got to tell you something. I didn't get something better. I went through healthcare.gov. I bought an unsubsidized ObamaCare policy, the bronze plan. I am like any other consumer. I bought on price.

What is the cheapest thing I could afford? That was the bronze plan. The premium was unbelievable. It was three times what I had paid for a premium before for my so-called junk insurance which I had had for years, which had covered every medical contingency that had occurred in my family's life for a number of years. But now I have to buy this policy that the premium was unbelievably high. But that wasn't the worst part, Mr. Speaker. The worst part was the deductible.

Now, look, I had a health savings account. I bought one as soon as the old medical savings accounts were allowed with the passage of the Kennedy-Kassebaum bill in, I think it was, July of 1996. The rules got written the next year. People were allowed to buy medical savings accounts. I bought one. I converted to a health savings account in 2004.

I thought I knew what a high deductible was. That was the whole purpose, after all, of having that medical savings account and, now, health savings account. You have a higher deductible so your premiums are going to be a little bit lower.

My premium certainly wasn't lower, but that deductible was something unlike anything I had ever seen. I went from a $3,500 deductible in my old health savings account with what then-President Obama said was a junk insurance policy. I went from a $3,500 premium to a $6,800 premium for just an individual. This is not a family policy, just for an individual.

Now, let me tell you something, Mr. Speaker. Someone wakes up at 3 in the morning with a kidney stone, the worst pain they have ever had in their life. They go to the emergency room basically to get a shot of morphine and an appointment with a urologist the next day and hopefully pass the darn thing. That exercise can cost in excess of $4,000. If you have a $6,800 deductible, guess what. That is all on you. Your coverage is meaningless at that point. And at the same time, you are having to pay a very expensive premium for coverage that is not there when you need it.

I am not an expert on this, Mr. Speaker, but I would call that junk insurance. That is what then-President Obama and the Congressional Democrats brought us with the passage of the so-called Affordable Care Act. I would far rather go back to those days before.

Most people don't understand why it is they have less coverage now and it costs them more money. Yeah, they heard the argument, if you like your doctor, you can keep your doctor; if you like your coverage, you can keep your coverage. They recognize that perhaps that was political hyperbole. But what they do not understand is: Why am I having to pay so much more now to get so much less?

Mr. Speaker, I submit that the ability for individuals to buy health savings accounts is not junk insurance. That is coverage that people can use. That is help for right now.

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

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

First off, Mr. Speaker, let me reference an article from the Investor's Business Daily from April 10 of this year. I am quoting Investor's Business Daily:

``When the Congressional Budget Office released its updated budget forecast, everyone focused on the deficit number. But buried in the report was the Congressional Budget Office's tacit admission that it vastly overestimated the cost of the Trump tax cuts because it didn't account for the strong economic growth they would generate.

``Among the many details in the report, the one reporters focused on was the Congressional Budget Office's forecast that the Federal deficit would top $1 trillion in 2020. . . .''

Most of the news accounts blame the tax cuts.

I am continuing to quote here:

``But there's more to the story that the media overlooked.

``First, the CBO revised its economic forecast sharply upward this year and next.

``Last June, the CBO said GDP growth for 2018 would be just 2 percent. Now it figures growth will be 3.3 percent''--this was last April, Mr. Speaker; I suspect it is probably going to be higher at the end of this quarter--``a significant upward revision. It also boosted its forecast for 2019 from a meager 1.5 percent to a respectable 2.4 percent.''

Mr. Speaker, the tax cuts are working to boost economic growth. Obviously, the story is far from completed, but the revenue generated by that increased growth is more than enough to offset the tax cuts that were passed by this body last December.

Mr. Speaker, today's rule allows the House to take another step in fixing the problems created by the Affordable Care Act and returning control of healthcare spending back to patients, where it belongs.

H.R. 6199, the Restoring Access to Medication Act of 2018, will allow those Americans with health savings accounts to use those accounts to pay for over-the-counter medications, the practice which existed up until the Democrats took away that ability in the Affordable Care Act. This is the right thing to do.

I want to thank Representative Jenkins for her leadership on this legislation and the Members who contributed to the package that is before us today. I urge my colleagues to support today's rule and support the underlying bills.

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

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 3728) to amend title VII of the Public Health Service Act to reauthorize certain programs relating to the health professions workforce, and for other purposes, as amended.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and insert extraneous material into the Record on the bill.

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

Mr. Speaker, as the author of the Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness Act of 2018, I rise in strong support of this bill. H.R. 3728 moved with strong bipartisan support through regular order in the full Energy and Commerce Committee and the subcommittee, which I chair. This legislation reauthorizes the title VII health professions workforce program for fiscal years 2019 through 2023.

Title VII programs have expired but have continued to receive appropriations. In fact, in fiscal year 2018, the appropriations levels for the program actually increased. Reauthorizing these physician workforce programs will provide much-needed stability for those who depend upon this funding.

Title VII of the Public Health Service Act includes various programs that are vital to building and maintaining a well-educated, well- trained physician workforce.

The EMPOWER Act reauthorizes funding for the Area Health Education Centers at more than $38 million a year. These centers are critical in providing both medical education and healthcare services to medically underserved areas.

The bill also reauthorizes programs that incentivize diversity in the physician workforce, including the Centers of Excellence Program, which this bill authorizes at a level of $23 million per year. This particular program provides grants to medical schools that have a disproportionate number of minority students for the purpose of expanding the schools' capacity or to improve curriculum.

Primary care is an important aspect of our Nation's healthcare system and how many Americans receive the majority of their healthcare services. H.R. 3728 reauthorizes funding for our Primary Care Training and Enhancement Program at more than $48 million per year. This program provides grants to hospitals and health professional schools to develop and operate supplemental primary care training programs.

Lastly, this bill aims to strengthen our workforce that cares for the geriatric population. The bill makes strides toward modernizing the Geriatrics Workforce Enhancement Program and the Geriatric Academic Career Award. With an aging population, our workforce needs to be adequately trained in handling the unique needs of our seniors. These two programs enable physicians and other providers to achieve that training.

Lastly, I want to thank Representatives Schakowsky and Bucshon and their staffs and the majority and minority staffs on the Energy and Commerce Committee for their work on this legislation.

Reauthorizing title VII programs is long overdue, especially in a time where our existing physician workforce is struggling to keep up with the demands for healthcare services. I urge strong support of the legislation, and I reserve the balance of my time.

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

Mr. Speaker, I would just point out that reauthorizing these title VII programs is long overdue. The House of Representatives in the last Congress, the 114th Congress, did provide the reauthorization. It never made it through the other body, unfortunately. It is time to do that work now, and that is what this bill, today, purports to do.

Mr. Speaker, this is an important bill. It is long overdue. I urge all Members to support the bill, and I yield back the balance of my time.

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 5385) to amend the Public Health Service Act to reauthorize the program of payments to children's hospitals that operate graduate medical education programs, and for other purposes, as amended.

Mr. Speaker, I ask unanimous consent that all Members

may have 5 legislative days in which to revise and extend their remarks and insert extraneous material in the Record on the bill.

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

Mr. Speaker, today we are considering H.R. 5385, the Dr. Benjy Frances Brooks Children's Hospital Graduate Medical Education Support Reauthorization Act of 2018. This bill, which was submitted by Representative Gene Green and myself, reauthorizes the Children's Hospital Graduate Medical Education programs at $325 million per year for the fiscal years 2019 through 2023. This is an increase of $10 million above the enacted fiscal year 2018 level. This bill recently moved through regular order in the Energy and Commerce Committee and its Subcommittee on Health.

Congress created the Children's Hospital Graduate Medical Education program in 1999 as part of the Healthcare Research and Quality Act, which authorized funding to directly support medical residency training at children's hospitals for 2 years.

Prior to the establishment of Children's Hospital Graduate Medical Education, children's hospitals received minimal graduate medical education funding because Medicare is the primary funding source of graduate medical education programs, and children's hospitals have few Medicare patients.

Since the establishment of this program, Children's Hospital Graduate Medical Education funding has provided critical support to our pediatric workforce, which still is struggling to keep up with the demands for their services. The Children's Hospital Graduate Medical Education program is especially crucial in training pediatric subspecialists.

Children's hospitals have a unique patient population with medical conditions from which pediatric medical residents can learn and develop critical skills. The experience gained from such a residency helps to prepare and train physicians for the complex reality of pediatric medicine that they will face in the future of their medical careers.

I can say as an OB/GYN who did his residency at Parkland Hospital in Dallas, residency programs play a vital role in shaping our Nation's physician workforce. Our pediatric workforce is no exception.

According to the Children's Hospital Association, almost half of children's hospitals reported vacancies for child and adolescent psychiatry, in addition to developmental pediatrics. The Children's Hospital Association also reports that pediatric specialists in emergency medicine, physical medicine, rehabilitation, endocrinology, rheumatology, hospitalists, pain management/palliative care, and adolescent medicine are frequently reported as experiencing vacancies longer than 12 months.

The workforce shortage is something that I am concerned about, and that is why passing this legislation is an integral part of maintaining and sustaining our workforce.

In 2016, Children's Hospital Graduate Medical Education funding helped to support over 7,000 residents at 58 hospitals across the country.

Mr. Green and I agreed to name this bill after Dr. Benjy Frances Brooks, who was born and raised in my district in north Texas, in Lewisville, Texas. Dr. Brooks went on to become the first female pediatric surgeon in the State and to establish pediatric surgery as a separate division at the University of Texas Medical School at Houston. It is an honor to move this bill in Dr. Brooks' name.

Our children deserve the best care available to them, and ensuring that we have an adequately prepared workforce is the first step in providing quality healthcare to children. Passing H.R. 5385 is vital to the maintenance and growth of this workforce and to the health of our Nation's children.

I urge support of this legislation, and I reserve the balance of my time.

Mr. Speaker, I yield as much time as he may consume to the gentleman from Oregon (Mr. Walden), chairman of the full committee.

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

I only want to point out that 2018 is the 100-year anniversary of the birth of Dr. Benjy Brooks, so it seemed an appropriate time to recognize her contributions to the fields of pediatric surgery and medicine in general.

Again, she was born in the town in which I practiced medicine for a number of years. I first encountered her at the University of Texas Medical School at Houston when I was a medical student back there in the 1970s. Surely, hers is a legacy of which all Texans can be proud.

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

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 959) to amend title VIII of the Public Health Service Act to extend advanced education nursing grants to support clinical nurse specialist programs, and for other purposes, as amended.

Mr. Speaker, I ask unanimous consent that all Members have 5 legislative days to revise and extend their remarks and insert extraneous material in the Record on the bill.

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

Mr. Speaker, I rise in support of H.R. 959, the Title VIII Nursing Workforce Reauthorization Act of 2018, which was introduced by the gentleman from Ohio (Mr. Joyce).

The bill reauthorizes the title VIII Nursing Workforce Development Programs for fiscal years 2019 through 2023. Title VIII programs, in addition to the title VII physician workforce programs, expired several years ago, but have continued to receive appropriations. This bill reauthorizes title VIII programs at the fiscal year 2018 level.

While our appropriations process has continued to fund these programs without a reauthorization, there remains uncertainty regarding how much money the programs will receive each year.

These programs range from providing our advanced practice nurses with additional educational opportunities to increasing the nursing workforce diversity.

The bill includes grants for nurses at different levels of education to obtain further education so that they can advance within the nursing profession. Additionally, this legislation reauthorizes loan repayment scholarships and grants for education, practice, quality, and retention. These provisions are essential in educating and retaining a qualified nurse workforce.

Mr. Speaker, I urge Members to support H.R. 959, and I reserve the balance of my time.

Mr. Speaker, I yield such time as he may consume to the gentleman from Ohio (Mr. Joyce), the author of the bill.

Mr. Speaker, I yield myself the balance of my time, and only to point out that this bill did pass in the previous Congress, in the 114th Congress, both in subcommittee and full committee, but was never enacted into law.

The author of that bill in the last Congress was our colleague, Lois Capps, on the Energy and Commerce Committee, and I know she will be grateful to see that her work has finally cleared the floor of the House and on to the Senate, and we will be successful.

Mr. Speaker, I yield back the balance of my time, and I urge an ``aye'' vote.

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

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

Mr. Chair, I rise today to offer an amendment on an issue I have worked on for several years on the Committee on Energy and Commerce as the authorizing committee.

In 2006, the Committee on Appropriations, without an authorization from the Committee on Energy and Commerce, included a provision in the annual Department of the Interior EPA Appropriations bill to allow the Environmental Protection Agency to begin using a special paid program that was explicitly and exclusively authorized for use by the Public Health Service Administration under the Department of Health and Human Services.

The special pay mechanism allows a government employee to leave the normal GS pay scale and receive nearly uncapped compensation. This provision was intended to be used only in unique circumstances for leaders in the healthcare industry who would never leave the private sector to work for the Federal Government except for those special, more competitive salaries.

Under current law, this justification can never be used at the Environmental Protection Agency. Indeed, some of the employees that the Environmental Protection Agency pays under title 42, the part of the U.S. Code that allows for this special pay, were previous government workers who were merely moved into the special pay scale because they desired more money.

The Environmental Protection Agency has claimed in the past that because the Environmental Protection Agency is a health organization, it may use this statute to pay special hires, and the Committee on Appropriations has agreed to let them, despite the authorizing committee's objection.

Originally, the Environmental Protection Agency was granted only a handful of slots to fill with title 42 hires. That number has now increased to over 50. The cost to the taxpayers for these employees is tens of millions of dollars.

This amendment would prevent the Environmental Protection Agency from hiring any new employees under title 42, or transferring any current employees from the GS scale to title 42. It would not effect current employees being paid under this provision. This would give the Committee on Energy and Commerce, the authorizing committee, the time it needs to address whether the EPA truly deserves the special pay consideration.

The Government Accountability Office looked into the Department of Health and Human Services' abuse of title 42 several years ago, and found problems with the implementation of this program. Within the Department of Health and Human Services where, arguably, this could be allowed, why would Congress ever allow the Environmental Protection Agency to implement the same problematic pay structure?

In multiple hearings in the Energy and Commerce Committee, both former Administrator Lisa Jackson and former Administrator Gina McCarthy refused to give specifics regarding the program. A Freedom of Information Act request by the EPA union, the American Federation of Government Employees, sent to my office showed that title 42 hires at EPA are, in fact, sowing dissent among workers, with the union asking the Congress to stop this abusive and unfair hiring technique.

A report by the Environmental Protection Agency's own inspector general in 2015 discovered that the EPA did not properly demonstrate a need to use the title 42 hiring authority, nor did it provide clear and convincing justification for its continued use. This is further proof that the Environmental Protection Agency's use of the title 42 hiring authority must come to an end.

I have introduced legislation further clarifying that the Public Health Services Act, written for HHS, does not permit the EPA to use this language to hire employees under a special pay structure.

Mr. Chairman, I urge adoption of the amendment, and I reserve the balance of my time.

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

It is a reasonable amendment. It only affects employees who are new hires in title 42 in the Environmental Protection Agency, not in the CDC and not in NIH. It is an amendment that would allow the authorizing committee an opportunity to catch up with what the Appropriations Committee has done without an authorization.

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

Mr. Speaker, I rise today to speak in support of this important, bipartisan bill to modernize the regulation of over-the- counter medicines.

An over-the-counter product is one that the Food and Drug Administration has found to be safe and effective for direct consumer use. To date, consumers have access to over 300,000 of these nonprescription items. We are all familiar with these products, from cough and cold medicines to antiperspirants, antacids, and sunscreens. Our pharmacy aisles and medicine cabinets are filled with over-the- counter products that American consumers rely on each and every day.

These products do not need premarket approval but are required to be consistent with monographs established by the Food and Drug Administration. Making a simple change to existing monographs requires a time-consuming and resource-intensive rulemaking process that can, in fact, take years to effectuate even if the change is to enhance the safety of a product. This creates undue delay in potential benefits seen by consumers and is an inefficient use of public resources.

Fortunately, the Food and Drug Administration, patient and consumer groups, and the regulated industry all agreed that reform is necessary and have spent the past several years engaged in discussions about modernization of the over-the-counter regulation. Congress worked with these groups to turn these discussions into legislation that we are considering this afternoon.

This bill would make the over-the-counter regulatory framework more science based and responsive to public health concerns. It would encourage the development of more innovative products and would provide resources to the Food and Drug Administration to bolster the agency's ability to review over-the-counter applications and regulate this sector in a consistent manner.

Quite simply, it is a meaningful bill for each American.

I want to thank our Energy and Commerce Committee Members, Representatives Latta from Ohio, Diana DeGette from Colorado, Brett Guthrie from Kentucky, Debbie Dingell from Michigan, as well as Ranking Member Green, my colleague from Texas, for their leadership in this legislation.

I also want to recognize the hard work and the dedication of committee staff on this legislation, particularly Warren Burke and Michelle Vanek of the Office of Legislative Counsel; Danielle Steele, with our majority staff; and Kim Trzeciak, with the committee's Democratic staff. I urge my colleagues to support the passage of this bill.

Mr. Speaker, I thank the gentleman for yielding.

Mr. Speaker, I rise to speak in support of this critical bill to reauthorize the Animal Drug User Fee Act and the Animal Generic Drug User Fee Act for an additional 5 years. Among other things, these user fees provide critical resources to the Food and Drug Administration's Center for Veterinary Medicine to ensure efficient and timely review of animal drug applications, quality assurance measures for animal feed, and surveillance of the safety and efficacy of animal drugs on the market.

In addition to reauthorizing these user fee programs, this legislation also includes new authority to facilitate greater innovation in the animal drug space.

Mr. Speaker, these user fee programs must be reauthorized by September 30 to avoid a major disruption of the operations of the Center for Veterinary Medicine. The clock is ticking. The agency must start sending pink slips to employees 60 calendar days before the end of the fiscal year. That is the end of this month.

We are talking about real consequences for animal health and for the American people. House passage of this bill today is an important step, and I urge the Senate to do its work and promptly take up and pass this bill so that President Trump can sign it into law. I thank the gentleman for the recognition.

Mr. Speaker, I rise today to honor the life of Mr. Turner F. Gassaway, Jr., who passed away in June at the age of 97.

Mr. Gassaway was raised on his family's farm in Elm Mott, Texas. He enlisted in the U.S. Army Air Corps during World War II. As a First Lieutenant, Gassaway flew 35 combat missions in a B-17 as part of the 388th Bombardment Group of the 8th Air Force based in southeast England. For his meritorious military service, Gassaway was awarded the Distinguished Flying Cross, the Air Medal with four Oak Leaf Clusters, and the European, African and Middle Eastern Campaign Medal with five Bronze Battle Stars.

Upon returning home, Mr. Gassaway began attending the University of Colorado at Boulder before transferring to the University of Texas at Austin. During his time at UT Austin, he pitched for the Longhorns. He received his degree from the University of Texas at Austin College of Pharmacy. In 1951, Gassaway moved to Denton where he owned and operated Gassaway Pharmacy and Apothecary for more than 30 years.

As a long-time business owner and pharmacist, Mr. Turner F. Gassaway, Jr. demonstrated his commitment to Denton and the wellbeing of his fellow citizens throughout his life. I am grateful for his service to our country and the North Texas community, and I offer my condolences to his family and loved ones.

Mr. Speaker, I rise today to honor the public service of Police Chief Lee Howell and thank him for his service to the greater Denton Community. Chief Howell has led the Denton Police Department since 2011. However, his service to Denton extends throughout his 37- year law enforcement career.

Chief Howell has fostered goodwill and civility between the Denton Police Department and local political and civic groups, elected officials, and the public. As our region grows, he has helped the police department expand to meet new needs.

During his tenure, Chief Howell has been responsible for enforcing the law, keeping the peace, and maintaining the safety of citizens. He has overseen the biannual Denton Police Academy that produced trained officers who now serve throughout the North Texas region.

It is my great privilege to recognize Chief Howell for his service, leadership, and commitment to excellence. Chief Howell's expertise and leadership will be missed by the greater Denton community. On behalf of the 26th District, I congratulate him as he starts a new leadership role as Chief of Police in Saginaw, Texas.

Mr. Speaker, by direction of the Committee on Rules, I

call up House Resolution 954 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentlewoman from California (Mrs. Torres), 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 may have 5 legislative days to revise and extend their remarks.

Mr. Speaker, House Resolution 954 provides for the consideration of a bill aimed at curbing the flow of illegal immigration across our southern border by combining a strong border wall and security measures with targeted modifications to the current immigration visa process.

The rule provides for one hour of debate on H.R. 4760, the Securing America's Future Act of 2018, with 40 minutes equally divided and controlled by the Committee on the Judiciary and 20 minutes controlled by the Committee on Homeland Security.

The rule provides for the adoption of the Goodlatte amendment reflecting a number of provisions, which were negotiated with numerous parties since the bill was first introduced in January of this year. This amendment will be incorporated into H.R. 4760 upon adoption of the rule today.

It also includes the McCaul amendment, which makes technical corrections to the underlying bill.

Further, the rule provides the minority with one motion to recommit with or without instructions.

The laws and legal agreement currently governing our enforcement efforts along the southern border are between 20 and 60 years old. America is a Nation built and continually supported by immigrants. However, the world has changed and how we accept new immigrants may adapt as well.

H.R. 4760 begins the process of reforming our immigration system for the first time in decades, and I encourage the passage of the rule to consider this important bill.

The Securing America's Future Act refocuses legal immigration for the skills that our country needs. It also secures our border, strengthens interior enforcement, and makes changes to the Deferred Action for Childhood Arrivals program. The diversity visa lottery program, which awards 50,000 green cards to a randomly selected pool of applicants, is eliminated, along with visas for relatives except for spouses and minor children. Overall, immigration levels are decreased, while visas for skilled workers are increased and the agricultural guest worker program is reformed to better meet the needs of our farmers and food processors.

Construction of a border wall system is authorized, including the use of additional cameras, sensors, and aviation assets. Recently, President Trump approved the use of the National Guard along the border, increasing capacity by over 1,100 personnel and 14 aircraft. This bill would also authorize the use of the National Guard aviation and intelligence support. It requires full implementation of the biometric entry-exit system at all ports of entry and provides for 10,000 border patrol agents and officers.

To strengthen interior enforcement, the bill mandates E-Verify so that all employers check the immigration status of their employees. It combats sanctuary city policies by withholding law enforcement grants and allows the Department of Homeland Security to detain dangerous, illegal immigrants who cannot be immediately removed from the country.

Many illegal immigrants without legal status claim asylum when apprehended by border agents. While there are legitimate claims of fear of persecution, there are also instances of immigrants being coached to say the correct phrase to obtain asylum. To combat this fraud, the bill increases the credible fear standard. It also makes being a gang member a removable offense and qualifies illegal presence as a Federal misdemeanor.

In 2015, Kate Steinle was killed by an immigrant without status while walking with her father in San Francisco. The man responsible for her death had been deported multiple times and should never have been in the country on that day.

Constituents of the 26th District of Texas experienced a similar tragedy in 2013 when a young girl in a crosswalk was struck and killed by someone in the country without legal status.

While the recent enforcement policies along our southern border have led to a temporary separation of parents and children, a father and a grandmother in the 26th District of Texas will never be reunited with their daughter and granddaughter.

Kate's Law enhances criminal penalties for multiple illegal reentry to help prevent future tragedies. Inclusion of this provision will reduce the possibility of the tragic killing of American citizens.

Finally, the bill provides for a 3-year renewable legal status for Deferred Action for Childhood Arrival recipients that allows them to work and travel overseas. This will apply to approximately 700,000 individuals who are currently in the United States. While it was not the fault of these then-children that they entered the country without legal documentation, the fact of the matter is that they are here now and we need a solution.

While I do not support an expedited path to citizenship, I do support allowing them to get in line and apply just like any other law-abiding potential immigrant. The bill does not allow for a special path to citizenship. However, it does allow the Deferred Action for Childhood Arrival recipient to obtain a green card and apply for citizenship like any other law-abiding applicant.

Recently, we have heard a lot about the enforcement policies along the southern border. Mr. Speaker, this crisis is not new. In 2014, the number of unaccompanied alien children increased exponentially and reached crisis levels. It remained steadily above 400,000 apprehensions from 2013 until the present.

During a visit by the Honduran First Lady in 2014, she was asked if Honduras wanted their children back, and without hesitation, she responded that they did. So a planeload of women and children was sent back to Honduras that resulted in an immediate reduction in the attempted crossings of unaccompanied alien children. However, because there was no follow-on enforcement actions, the numbers again began to increase, reaching above 563,000 in 2016.

In the lead-up to the 2010 election, the numbers increased, because then-candidate Trump spoke about securing our border with a wall that would finally end the possibility of illegal entry along our southern border. When candidate Trump became President-elect Trump, this number dramatically decreased because potential immigrants believed that construction of the border wall was imminent.

As a Member of Congress representing a border State, I have maintained regular contact with Customs and Border Protection and the Immigration and Customs Enforcement officials. What we heard during this period, 2016, was that immigrants crossing the border illegally wanted to get into the country before the possibility of a Trump election occurred and could direct construction of the border wall. They were under the impression that if

you crossed our border, at a point of entry or illegally, you would be granted amnesty and welcomed into the country. While we do welcome legal immigrants, this perception led to only more vulnerable children being entrusted by parents to human traffickers, typically for large sums of money, to bring their children to the United States.

On this journey, children could experience harsh conditions. Some were abused physically, sexually, and emotionally. And this abuse is not a threat just from the adults that are supposed to care for them, but also it can occur from their fellow travelers. A lot of these kids are just trying to survive, trying to make it to a life where they may one day thrive, but this existence is often all they have known, and they react in a way that reflects this reality.

While there is a concern about children arriving with parents who are then prosecuted for illegal entry and subsequently placed in the custody of the Health and Human Services Office of Refugee Resettlement, numerous children never get to make this journey with their parents or even relatives. Many adults are now bringing nonrelated children with them in an attempt to be released into the United States because of their association with a child that cannot, because of the Flores Agreement from 1997, be held in custody.

When the influx of unaccompanied alien children began exceeding the capacity of the Office of Refugee Resettlement, I traveled to the border area specifically to visit these facilities. I engaged with the Office of Refugee Resettlement to fully understand the care that these children were receiving in 2014, 2015, and 2016. The Office of Refugee Resettlement responded to my concerns about threats of communicable diseases from foreign countries being brought to our homeland. Mr. Speaker, there was not even a physician employed in the Office of Refugee Resettlement in 2014 before I raised this issue.

The issue became a concern because there were members of Customs and Border Control that actually felt that they were perhaps developing a condition as a result of contact with people because of a skin parasite that was easily communicated. And the question arose, could other diseases be communicated as well? And people were rightfully concerned about that. It is not just an illness like scabies; it is an issue like multiple-drug-resistant tuberculosis that people were most concerned about.

While treatment in facilities has vastly improved in the last couple of years, the path by which immigrants come here is still dangerous. On one of my visits near the border at McAllen, Texas, I traveled with border patrol agents along a cactus-strewn, dusty road, mesquite bushes growing in from the sides. They brought a bus down there, a big bus. They stopped, they flashed their lights, they honked their horn, and the bus filled up with people. The bus went off to town, bouncing across this dusty road, and I remained back with the Customs and Border Patrol.

Then a State agent came up, someone from Fish and Wildlife, and said: I need help. I have got people over here that I think belong in your jurisdiction because you are the Federal Government.

And Customs and Border Patrol went over to the area that he had pointed out, and here were a number of women, small children, and teenage boys. They had come across the river, delivered by traffickers, just literally on the other side of the river, and dropped there. They had no idea what was the direction to town. They were not equipped to travel in the harsh conditions. It was probably 110 degrees outside that day. Small children, children, babes in arms, probably 1 year of age or less: this is what the traffickers left on the side of the river.

Had the Fish and Wildlife Service not come by and the U.S. Customs and Border Patrol not come by, I don't know how these people would have made it to town. And it is quite possible they would not have made it safely.

So the situation along the southern border is not just a border crisis, it is also an immigration crisis. Attorney General Sessions announced a zero-tolerance policy to finally and fully enforce our laws. I believe he did this so that Americans and immigrants alike would recognize and remember that we are a Nation of laws, and also to demonstrate that the dangerous journey to our southern border is sometimes not worth the risk and the struggle required to make it within just a few miles of a fence.

The ebb and flow of border crossings has consistently reflected the rhetoric of American leadership and perception of enforcement of our laws. The rate of border crossings rapidly increased in the last year because there has been no significant visible action by the Congress to President Trump's request for a border wall. However, this is not the only factor.

It is no secret that countries in what are called the northern triangle, Honduras, Guatemala, and El Salvador, are some of the most dangerous countries in the world. Yet, these countries receive millions of dollars of aid each year for economic development, for military financing, and security initiatives.

This funding rapidly increased to more than $600 million each year beginning in fiscal year 2014, mostly in response to the growing crisis with unaccompanied alien children. So I think it is appropriate to ask ourselves, is the funding being allocated in a way that will help improve domestic conditions on the ground and reduce the desire to leave?

To address this concern, I introduced the Unaccompanied Alien Children Assistance Control Act, and I offered this bill as an amendment to H.R. 4760. Simply put, this bill would reduce foreign aid allocations to Mexico, Honduras, El Salvador, and Guatemala by $15,000 per child to each country if their child crosses the border illegally or if they are referred to the Office of Refugee Resettlement for custody and care.

While this may not seem like a lot, the reality is that each child cared for by the Office of Refugee Resettlement costs the American taxpayer about $35,000. Even Attorney General Sessions has stated that the care these children receive is better than the average American child.

While we cannot leave children without care, we must recognize that prioritizing alien children over our own sends the wrong message. Removing that $15,000 of foreign aid per child will send a message to Mexican and Northern Triangle leaders that our accepting their children will not be without cost to them.

As we all know, Mr. Speaker, if you want to make it important, it has to be about the money.

Unfortunately, the accountability in these countries is poor, and the use of funds largely goes unchecked. They rely on American aid, and we must ensure that it is being used appropriately and wisely to combat the forces that are driving their future generations--it is their future--away from their own countries.

By withholding funding in the face of rampant corruption, we not only provide a potential funding stream for President Trump's proposed border system, but we send a signal that we will not willingly deprive the children and desperate immigrants of the life they desire and need in their countries of origin.

The best place for a child and a family is their home. Because of the condition in the Northern Triangle countries, home for many children is now a stark facility along a foreign border.

It is time to take steps that would not only strengthen our immigration laws for the security of American citizens, but is in the interest of restoring and maintaining the home from which many would-be immigrants try to escape.

Congress has not successfully reformed our immigration laws in decades. It is time to begin that debate to align our immigration system with current realities. For this reason, I encourage the adoption of the rule to begin consideration of H.R. 4760, Securing America's Future Act.

Mr. Speaker, I urge my colleagues to support today's rule, and I reserve the balance of my time.

Mr. Speaker, I yield myself 1 minute.

Mr. Speaker, this is not a crisis of President Trump's making. Those of us who served here during the Bush administration were aware that this was a problem. Certainly, those of us who served during the Obama administration were aware that this was a problem.

When President Obama declared the Deferred Action for Childhood Arrivals in 2012, it was immediately followed, 2 years later, by the wave of unaccompanied alien children who came to our southern border. This crisis has been a long time in the making. Congress does need to solve this problem. The President is quite correct in that.

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

Mr. Speaker, I yield myself 1 minute.

Mr. Speaker, I would just point out that, under current conditions, current laws, the United States of America takes in 1.1 million new citizens every year. We are the most generous country on the face of the Earth. American citizens should be rightly proud of that.

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

Mr. Speaker, I yield myself 3 minutes.

Mr. Speaker, I just remind people in this body that 10 years ago the Democrats were in the majority. Indeed, then in the 2008 election that occurred 10 years ago, they strengthened that majority. House Republican Members were so far in the minority as to be irrelevant in all exchanges.

There was a 60-vote majority over in the Senate. You may recall that is where the Affordable Care Act and Dodd-Frank and other pieces of legislation that I would have thought would never pass actually did pass in that environment.

A question that I hear a lot is: Why didn't Democrats do something about the Dreamer problem when they controlled all the levers of power? And it is a valid question.

Senator Durbin had a bill, as you will recall, in that next session of Congress that began in January of 2009. Senator Durbin had a bill to deal with the Dreamer situation, and he worked on it all year. It never came up until December of 2010.

Now, you remember in November of 2010, actually, the majority changed in the House of Representatives and there were enough Republicans elected that the Democrats would not be in the majority the next year.

So here we are in a so-called lame duck session of a party that is exiting power, and I think it was December 8 of that year that, in the House, the Democrats brought Senator Durbin's bill up and passed it on the House floor, as would be expected. They did have a significant majority.

They lost one vote over in the Senate, as I recall, and had 59 Democrats. Speaker Pelosi told me at a Rules Committee hearing several months ago that it was then that the Republicans blocked that vote from happening in the Senate.

But that is not exactly true.

Three Republicans voted with the Democrats on the Durbin bill. Five Democrats voted in the negative, and that is what killed the Durbin bill when the Democrats controlled all levers of power in 2010, the last time they did.

Mr. Speaker, don't blame this problem on President Trump. It has been in existence for some time, but it is up to us to solve it.

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

Mr. Speaker, I yield such time as he may consume to the gentleman from Virginia (Mr. Goodlatte), the chairman of the Judiciary Committee and the author of H.R. 4760.

Mr. Speaker, may I inquire as to how much time I have remaining.

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

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

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

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

Mr. Speaker, I want to talk to you about a story of separation, a father and daughter who have been separated. Chris, my constituent, came to me with this story several years ago.

He served his country in Iraq. While he was serving his country in Iraq, his wife developed cancer and died. Chris returned home to be a single dad to his daughter.

His daughter went out with friends one night and was struck and killed by an automobile--an automobile driven by someone who was in the country without the benefit of citizenship.

Chris comes to my townhalls and asks me: While I was serving my country, you were supposed to be enforcing the laws on the border. Because you did not do your job, I am now separated from my daughter in perpetuity.

H.R. 4760, the Securing America's Future Act of 2018, is the product of months of work by Chairman Goodlatte, Chairman McCaul, and other stakeholders. This is an answer to our persistent problems with our immigration system that so many Members of this body have been talking about for years.

Mr. Speaker, I urge my colleagues to support today's rule and move the debate forward on this legislation.

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

Mr. Speaker, I ask unanimous consent that, notwithstanding House Resolution 949, during consideration of H.R. 6 pursuant to such resolution, general debate shall not exceed 1 hour, with 40 minutes equally divided and controlled by the chair and ranking minority member on the Committee on Energy and Commerce and 20 minutes equally divided and controlled by the chair and ranking minority member of the Committee on Ways and Means.

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 949 and ask for its immediate consideration.

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

General Leave

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

Mr. Speaker, House Resolution 949 provides for the consideration of three important bills aimed at curbing the deadly opioid epidemic plaguing this country and providing Americans with the tools to overcome their addictions: H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, or the SUPPORT Act; H.R. 5797, the Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act; and H.R. 6082, the Overdose Prevention and Patient Safety Act.

The three bills included in today's rule all seek to accomplish one goal: assist Americans struggling with opioid addiction in controlling their addictions and moving forward in achieving productive and healthy lives.

The rule provides for 1 hour of debate on H.R. 6, equally divided and controlled by the chair and ranking minority member of the Committee on Energy and Commerce. The rule makes in order eight amendments offered by both Republicans and Democrats. Further, the rule provides the minority with one motion to recommit with or without instructions.

The resolution also provides for a structured rule for H.R. 5797, allowing 1 hour of debate to be divided and controlled between the chair and ranking minority member of the Energy and Commerce Committee. The rule also provides for debate on an amendment by Mrs. Mimi Walters of California, an active member of the Energy and Commerce Committee. Finally, the rule provides the minority with the customary motion to recommit with or without instructions.

The final bill included in today's resolution, H.R. 6082, will also receive 1 hour of debate on the House floor, equally divided and controlled by the chair and ranking member of the Energy and Commerce Committee. As the Committee on Rules received no germane amendments to H.R. 6082, no amendments were made in order in today's rule. The minority does receive the customary motion to recommit with or without instructions.

The statistics that many of us have heard on numerous occasions--at our district townhalls, in opioid roundtables with stakeholders, constituent meetings in our offices, and in our committee hearings--are truly heartbreaking stories, with more than 115 people dying in the United States every day from an opioid overdose. That is five people per hour.

According to national reports, emergency room visits and opioid overdose deaths have more than quadrupled in the last 15 years, and a preliminary analysis indicates those numbers are to rise. The misuse of and addiction to opioids--including prescription pain medications, heroin, and synthetic opioids such as fentanyl--is, indeed, an urgent national crisis that continues to threaten our public health, social fabric, and economic welfare. Both community hospitals and local paramedics are frequently coming across people overdosing on an opioid drug or a drug laced with fentanyl.

The opioid epidemic has affected families not only in my district in north Texas, but in communities large and small from Maine to California. It has also impacted American employers and businesses due to lost productivity and difficulty finding qualified candidates for employment. President Trump is right to call this epidemic the ``crisis next door.''

The efforts of the Energy and Commerce Committee in the Comprehensive Addiction and Recovery Act and the 21st Century Cures Act in the previous Congress were a good start, delivering critical funding and resources to communities hit most hard by the opioid epidemic. But there was much more we still could do.

To start this process, the Energy and Commerce Health Subcommittee, which I chair, held a Member Day last October, where more than 50 bipartisan Members of this body, both on and off the committee, shared their personal stories from their districts and offered their solutions. This was followed by a series of three legislative hearings with markups where nearly 60 bills were considered and advanced to the full Energy and Commerce Committee that acted on these bills shortly thereafter.

The culmination of the work from the Energy and Commerce Committee and other House committees has brought us to consider many of these policies over the course of the last 2 weeks on the House floor. It required an all-hands-on-deck approach, and I believe the American people will see that, by this week's end, we did, indeed, come together in a bipartisan fashion and worked to address this crisis.

Today's rule provides for consideration of three important bills that will expand treatment options, deliver lifesaving services, and make necessary public health reforms, including Medicare and Medicaid, to bolster prevention and recovery efforts.

First, H.R. 5797, the Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act, the IMD CARE Act, allows State Medicaid programs to remove the institutions for mental diseases exclusion for beneficiaries aged 21 to 64 with an opioid use disorder for 5 years' time. The bill provides the continuum of care

by removing a barrier of care under current law, so Medicaid can cover up to a total of 30 days of care in an institute for mental disease during a 12-month period, and eligible enrollees can get the care that they actually need.

The IMD exclusion is one of the treatment barriers consistently identified by State Medicaid directors, health policy experts, and many provider groups. Currently, this exclusion under Medicaid significantly limits the circumstances under which Federal Medicaid matching funds are available for inpatient services or for outpatient treatments.

Unfortunately, this policy has barred individuals with an opioid use disorder and mental illness from accessing short-term, acute care in psychiatric hospitals, or receiving treatment in residential substance use disorder treatment facilities. A 2017 Medicaid and CHIP Payment and Access Commission report stated that the Medicaid IMD exclusion is one of the few examples in the Medicaid program where Federal financial participation cannot be used for medically necessary and otherwise covered services for a specific Medicaid population receiving treatment in a specific setting.

In the midst of the opioid crisis, States must leverage all available tools to combat this epidemic. Section 1115 demonstration waivers are an important tool, but, so far, less than half of the States have sought or received an appropriate waiver from the Centers for Medicare and Medicaid Services to help patients with substance use disorder.

The IMD CARE Act also allows States the option to use the State plan amendment process, which is generally faster than using waivers. Under this process, once a State plan amendment is submitted, the Centers for Medicare and Medicaid Services has 90 days to decide or the proposed change will automatically go into effect.

H.R. 5797 amends an outdated law that has been in effect since the enactment of the Medicaid program in 1965. Since that time, there have been advances in behavioral health, and there have been advances in addiction treatment services where more, improved treatment options now exist.

It is long overdue to revisit this policy so that State Medicaid programs can better meet patients' needs and physicians can determine the most appropriate setting for care based on an individual's treatment plan.

Next, H.R. 6082, the Overdose Prevention and Patient Safety Act, makes timely reforms to a privacy law that affects patient access to healthcare and creates barriers to treatment. Specifically, the bill updates the Public Health Service Act to permit substance use disorder records to be shared among covered entities and 42 CFR part 2 programs by aligning part 2 with the Health Insurance Portability and Accountability Act of 1996 for the purposes of treatment, payment, and healthcare operations.

As a physician, I believe it is vital that when making clinical decisions, I have all of the appropriate information to make the correct determination in the treatment of a particular patient. Those suffering from substance use disorder should receive the same level of treatment and care as other individuals.

Patients afflicted with substance use disorder deserve to be treated by physicians who are armed with all of the necessary information to provide the best possible care.

I certainly do understand and respect that patient privacy protection is paramount and should be held in the highest regard.

The Overdose Prevention and Patient Safety Act maintains the original intent of the 1970s statute behind 42 CFR part 2 by protecting patients and improving care coordination. In fact, this bill increases protections for those seeking treatment by more severely penalizing those who share patient data to noncovered entities and non-part 2 programs than under the current statute, with certain exceptions.

Lastly, it requires the Secretary of Health and Human Services to, among other things, issue regulations prohibiting discrimination based on disclosed health data and requiring covered entities to provide written notice of privacy practices.

The issue of the stigma associated with substance use disorder has been a constant in many of the discussions members of the Energy and Commerce Committee and the stakeholders have had in both our offices and in our hearings.

This carefully crafted legislation seeks to help break the stigma and help individuals with this complex disease gain access to healthcare and support services critical to getting them on the road to recovery.

We should not continue to silo the substance use disorder treatment information of a select group of patients if we want to ensure that these patients are indeed receiving quality care. This information should be integrated into our medical records and comprehensive care models to prevent situations where physicians, not knowing a patient's substance use disorder, may prescribe medications that have significant drug interactions, or worse, may prescribe a controlled substance that makes their patient's substance use disorder worse.

As it currently stands, 42 CFR part 2 is actively prohibiting physicians from ensuring proper treatment and patient safety and, paradoxically, it is perpetuating that stigma.

Providing high quality healthcare is a team effort, but physicians leading the team must have the necessary information to adequately coordinate care. We must align payment, operations, and treatment to allow coordination of both behavioral and physical health services for individuals with substance use disorder.

There is a reason why the Substance Abuse and Mental Health Services Administration and most of the health stakeholder community are asking for this change. Clearly, there is an issue here that must be addressed. H.R. 6082 achieves the goal and contributes to Congress' effort in trying to stem the current crisis.

Finally, Mr. Speaker, H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, is a package of bills that reform Medicare, Medicaid, and other health provisions to further combat this crisis by advancing many critical initiatives.

As we all know, this opioid epidemic is in our hospitals, but it is also in our living rooms and on our streets. Our partners at Federal agencies must rise to the challenge and deliver vital resources for States and communities most devastated by the crisis. The SUPPORT for Patients and Communities Act will provide our Department of Health and Human Services, including the Centers for Medicare and Medicaid Services and the Food and Drug Administration, with the necessary tools to address this crisis.

Title I of H.R. 6 addresses the ways in which Medicaid can be used to increase access to quality care and management for individuals suffering from substance use disorders. Some of these changes in Medicaid reflect the success of our State Medicaid programs by implementing State successes at the Federal level.

Section 101 under title I will expand protection for at-risk youth by requiring State Medicaid programs to restore Medicaid coverage of a juvenile following their release from incarceration. The next section also allows former foster youth to maintain their Medicaid coverage across State lines until they turn 26 years of age. These are vulnerable populations of individuals that will greatly benefit from increased access to treatment.

Section 105 builds on the current State Medicaid drug utilization review, which saves money and promotes patient safety. This section will require State Medicaid programs to have safety edits in place for opioid refills, monitor concurrent prescribing of opioids and certain other drugs, and monitor antipsychotic prescribing for children.

Care for mothers suffering from substance use disorder and their babies who are born with neonatal abstinence syndrome is a growing problem in the face of this epidemic. Section 106 requires HHS to improve care for these infants with neonatal abstinence syndrome and their mothers. It also requires that the General Accountability Office study the gaps in Medicaid coverage for pregnant and postpartum women with substance use disorders.

Section 107 of the bill provides additional incentives for Medicaid health homes for patients with substance use disorder.

Mr. Speaker, these health homes will allow States to create a comprehensive person-centered system of care coordination for primary care, acute and behavioral healthcare, including mental health and substance use. As our healthcare system moves towards caring for the whole person, it is important that we enable our physicians and our payers to provide that comprehensive care.

The SUPPORT for Patients and Communities Act also enables better pain management for our Nation's Medicare beneficiaries, ranging from increased access to substance use disorder treatment, including through the use of telehealth, to modification of physician payment for certain nonopioid treatments in Ambulatory Surgery Centers.

Title II of the bill contains Medicare provisions that encourage the use of nonopioid analgesics where appropriate and also aims to decrease fraud and abuse regarding prescriptions by requiring e-prescribing for the coverage of Medicare Part D controlled substances.

H.R. 6 strives to provide support for at-risk beneficiaries who might fall victim to substance use disorder. Section 206 of the bill accelerates the development and the use of drug management programs for at-risk beneficiaries. While this program is currently voluntary, by plan year 2021, it will become a mandatory program.

Lastly, the bill expands Medicare coverage to include opioid treatment programs for the purpose of providing medication-assisted treatment. Opioid treatment programs are not currently Medicare providers, which forces Medicare beneficiaries who need medication- assisted treatment to pay out-of-pocket costs for those services. These efforts should provide improved access to treatment for Medicare beneficiaries who have substance use disorders while also incentivizing the use of opioid alternatives, which hopefully will prevent the development of substance use disorders.

Even though an estimated 46,000 Americans died from opioid overdoses from October 2016 to October 2017, there is a lack of innovation and a lack of investment in the development of nonaddictive pain and addiction treatment.

A bill that I introduced, H.R. 5806, the 21st Century Tools for Pain and Addiction Treatments, is included in section 301 on H.R. 6 and requires the Food and Drug Administration to hold at least one public meeting to address the challenges and the barriers of developing nonaddictive medical products intended to treat pain or addiction.

The Food and Drug Administration is also required to issue or update existing guidance documents to help address challenges to developing nonaddictive medical products to treat pain or addiction.

Mr. Speaker, I did work closely with the Food and Drug Administration to get the policy in this section correct and to ensure that it will clarify those pathways for products that, in fact, are so desperately needed by America's patients.

I have remaining concerns about the language in section 303 that will allow nonphysician providers to prescribe buprenorphine. While I understand and greatly appreciate the intent to increase access to medication-assisted treatment, as a physician, I also respect how complicated the treatment of patients suffering from substance use disorder may be.

The Hippocratic Oath, we all know, is to first, do no harm. Patient safety should be our highest priority.

This is a complex patient population, Mr. Speaker. On average, people with substance use disorder die 20 years sooner than other Americans.

Additionally, buprenorphine is a schedule III drug that can be misused and could exacerbate the underlying problem. I am unsure about expanding these authorities to additional nonphysician providers at the risk of making the problem worse. I have worked to strengthen the reporting requirements of this section of H.R. 6 and look forward to reviewing that report on this particular policy.

Taken together, H.R. 6, the SUPPORT for Patients and Communities Act, will improve access to care for individuals suffering from substance use disorder, provide our healthcare system with tools and resources that it needs to care for patients, and to help prevent future misuse of opioids.

Before I close, I would like to share a quote from President Trump. He said: ``Together, we will face this challenge as a national family with conviction, with unity, and with a commitment to love and support our neighbors in times of dire need. Working together, we will defeat this opioid epidemic.''

The number of bills and policies advanced on the House floor in the last 2 weeks illustrates our shared commitment, and I am confident that we will make significant progress in defeating this epidemic.

Mr. Speaker, I urge my colleagues to support today's rule and the three underlying bills that are critical to our Nation's effort to stem the opioid crisis.

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

Mr. Speaker, I yield 3 minutes to the gentleman from Pennsylvania (Mr. Costello), a fellow member on the Committee of Energy and Commerce.

I yield the gentleman from Pennsylvania an additional 1 minute.

Mr. Speaker, I yield myself 1 minute.

I do want to remind everyone that 18 months ago, in the previous Congress, with the passage of the 21st Century Cures Act and the Comprehensive Addiction Recovery Act, CARA, $1 billion was made available for treating people with substance use disorder. That was then supplemented with the passage of the more recent appropriations bill last month--2 months ago, with $4 billion.

Unprecedented amounts of money have been made available in the last 18 months to combat this crisis.

And then, finally, it is very, very difficult to integrate care if you don't reform the 42 CFR part 2, which is before us today.

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

Mr. Speaker, I yield myself 2 minutes.

Mr. Speaker, the good news is that all forms of medication-assisted treatment are required for 5 years under H.R. 6. So I look forward to the gentleman's support when we get to the vote, and I reserve the balance of my time.

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

Mr. Speaker, I don't need to remind anyone that the lie of the year for 2012 was: If you like your doctor, you can keep your doctor--words that will ring through this body probably for the rest of time.

I want to read from the Statement of Administration Policy, back to the business at hand, the rule on the three bills that we are considering today. This is the Statement of Administration Policy: ``Addressing the opioid crisis has been a top priority of the President since day one, and the administration welcomes legislation that complements its efforts to end the opioid crisis. The administration strongly supports House passage of bipartisan bills to protect patients enrolled in Medicare and Medicaid, create targeted programs for at-risk populations, expand access to medication-assisted treatment for opioid use disorders, and provide resources for States and communities struggling to deal with the scale of the opioid crisis.''

The statement goes on, and it concludes: ``These initiatives represent bold, evidence-based steps to prevent and treat opioid abuse, and will help save the lives of countless Americans. The administration commends the House on taking up these important bills. . . . The administration supports House passage of H.R. 5797, H.R. 6082, and H.R. 6. . . .''

Mr. Speaker, today's rule provides for the consideration of these three important pieces of legislation aimed at

addressing the opioid crisis affecting so many of our fellow Americans.

H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act; H.R. 5797, the Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act; and H.R. 6082, the Overdose Prevention and Patient Safety Act, will all play a critical role in treating patients and providing Americans the tools to put the pieces of their lives back together again.

I commend Chairman Walden for his efforts on bringing so many Members of this body into the discussion and taking the many ideas offered by Members, incorporating them into the legislative products. The result of those efforts is a legislative trio that this entire body can be proud of, and this entire body can support.

I, therefore, urge my colleagues to support today's rule and the three underlying pieces of legislation.

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

An Amendment to H. Res. 949 Offered by Mr. McGovern

At the end of the resolution, add the following new

sections:

Sec. 5. Immediately upon adoption of this resolution the

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

the House resolved into the Committee of the Whole House on

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

4501) to increase funding for the State response to the

opioid misuse crisis and to provide funding for research on

addiction and pain related to the substance misuse crisis.

The first reading of the bill shall be dispensed with. All

points of order against consideration of the bill are waived.

General debate shall be confined to the bill and shall not

exceed one hour equally divided and controlled by the chair

and ranking minority member of the Committee on Energy and

Commerce. After general debate the bill shall be considered

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

against provisions in the bill are waived. At the conclusion

of consideration of the bill for amendment the Committee

shall rise and report the bill to the House with such

amendments as may have been adopted. The previous question

shall be considered as ordered on the bill and amendments

thereto to final passage without intervening motion except

one motion to recommit with or without instructions. If the

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

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

the House shall, immediately after the third daily order of

business under clause 1 of rule XIV, resolve into the

Committee of the Whole for further consideration of the bill.

Sec. 6. Clause 1(c) of rule XIX shall not apply to the

consideration of H.R. 4501.

The Vote on the Previous Question: What It Really Means

This vote, the vote on whether to order the previous

question on a special rule, is not merely a procedural vote.

A vote against ordering the previous question is a vote

against the Republican majority agenda and a vote to allow

the Democratic minority to offer an alternative plan. It is a

vote about what the House should be debating.

Mr. Clarence Cannon's Precedents of the House of

Representatives (VI, 308-311), describes the vote on the

previous question on the rule as ``a motion to direct or

control the consideration of the subject before the House

being made by the Member in charge.'' To defeat the previous

question is to give the opposition a chance to decide the

subject before the House. Cannon cites the Speaker's ruling

of January 13, 1920, to the effect that ``the refusal of the

House to sustain the demand for the previous question passes

the control of the resolution to the opposition'' in order to

offer an amendment. On March 15, 1909, a member of the

majority party offered a rule resolution. The House defeated

the previous question and a member of the opposition rose to

a parliamentary inquiry, asking who was entitled to

recognition. Speaker Joseph G. Cannon (R-Illinois) said:

``The previous question having been refused, the gentleman

from New York, Mr. Fitzgerald, who had asked the gentleman to

yield to him for an amendment, is entitled to the first

recognition.''

The Republican majority may say ``the vote on the previous

question is simply a vote on whether to proceed to an

immediate vote on adopting the resolution . . . [and] has no

substantive legislative or policy implications whatsoever.''

But that is not what they have always said. Listen to the

Republican Leadership Manual on the Legislative Process in

the United States House of Representatives, (6th edition,

page 135). Here's how the Republicans describe the previous

question vote in their own manual: ``Although it is generally

not possible to amend the rule because the majority Member

controlling the time will not yield for the purpose of

offering an amendment, the same result may be achieved by

voting down the previous question on the rule. . . . When the

motion for the previous question is defeated, control of the

time passes to the Member who led the opposition to ordering

the previous question. That Member, because he then controls

the time, may offer an amendment to the rule, or yield for

the purpose of amendment.''

In Deschler's Procedure in the U.S. House of

Representatives, the subchapter titled ``Amending Special

Rules'' states: ``a refusal to order the previous question on

such a rule [a special rule reported from the Committee on

Rules] opens the resolution to amendment and further

debate.'' (Chapter 21, section 21.2) Section 21.3 continues:

``Upon rejection of the motion for the previous question on a

resolution reported from the Committee on Rules, control

shifts to the Member leading the opposition to the previous

question, who may offer a proper amendment or motion and who

controls the time for debate thereon.''

Clearly, the vote on the previous question on a rule does

have substantive policy implications. It is one of the only

available tools for those who oppose the Republican

majority's agenda and allows those with alternative views the

opportunity to offer an alternative plan.

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

Mr. Speaker, pursuant to clause 4 of rule XVI, I move that when the House adjourns on Wednesday, June 20, 2018, it adjourn to meet at 9 a.m. on Thursday, June 21, 2018, for morning-hour debate and 10 a.m. for legislative business.