[Congressional Record Volume 161, Number 51 (Thursday, March 26, 2015)]
[House]
[Pages H2038-H2045]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PROVIDING FOR CONSIDERATION OF H.R. 2, MEDICARE ACCESS AND CHIP
REAUTHORIZATION ACT OF 2015, AND PROVIDING FOR PROCEEDINGS DURING THE
PERIOD FROM MARCH 27, 2015, THROUGH APRIL 10, 2015
Mr. BURGESS. Mr. Speaker, by direction of the Committee on Rules, I
call up House Resolution 173 and ask for its immediate consideration.
The Clerk read the resolution, as follows:
H. Res. 173
Resolved, That upon adoption of this resolution it shall be
in order to consider in the House the bill (H.R. 2) to amend
title XVIII of the Social Security Act to repeal the Medicare
sustainable growth rate and strengthen Medicare access by
improving physician payments and making other improvements,
to reauthorize the Children's Health Insurance Program, and
for other purposes. All points of order against consideration
of the bill are waived. The amendment printed in the report
of the Committee
[[Page H2039]]
on Rules accompanying this resolution shall be considered as
adopted. The bill, as amended, shall be considered as read.
All points of order against provisions in the bill, as
amended, are waived. The previous question shall be
considered as ordered on the bill, as amended, and on any
further amendment thereto, to final passage without
intervening motion except: (1) one hour of debate equally
divided among and controlled by the chair and ranking
minority member of the Committee on Energy and Commerce and
the chair and ranking minority member of the Committee on
Ways and Means; and (2) one motion to recommit with or
without instructions.
Sec. 2. On any legislative day during the period from
March 27, 2015, through April 10, 2015--
(a) the Journal of the proceedings of the previous day
shall be considered as approved; and
(b) the Chair may at any time declare the House adjourned
to meet at a date and time, within the limits of clause 4,
section 5, article I of the Constitution, to be announced by
the Chair in declaring the adjournment.
Sec. 3. The Speaker may appoint Members to perform the
duties of the Chair for the duration of the period addressed
by section 2 of this resolution as though under clause 8(a)
of rule I.
Sec. 4. Each day during the period addressed by section 2
of this resolution shall not constitute a calendar day for
purposes of section 7 of the War Powers Resolution (50 U.S.C.
1546).
Sec. 5. The Committee on Financial Services and the
Committee on Ways and Means each may, at any time before 5
p.m. on April 6, 2015, file reports to accompany measures.
The SPEAKER pro tempore (Mr. Graves of Louisiana). The gentleman from
Texas is recognized for 1 hour.
Mr. BURGESS. 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.
{time} 0915
General Leave
Mr. BURGESS. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days to revise and extend their remarks.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. BURGESS. Mr. Speaker, House Resolution 173 provides for
consideration of H.R. 2, the Medicare Access and CHIP Reauthorization
Act of 2015, under a closed rule, reflecting the careful, intricate,
bipartisan negotiations which brought this legislation to the floor.
The rule provides for 1 hour of debate, equally divided among the
chairs and ranking members of the Committees on Energy and Commerce and
Ways and Means.
As is customary, the rule allows the minority to offer a motion to
recommit on the bill.
Finally, the rule provides for the customary district work period
authority.
This bill, H.R. 2, resolves an issue that many of us have worked on
for our entire congressional careers.
This bill reflects years of bipartisan work, work across committees,
and even work across the Capitol with the other body. We brought
together Members of all ideological groups, as well as diverse outside
groups. We coalesced around a policy that will help patients, help
doctors, help providers to get out from under the constant threat of
payment cuts under the Medicare sustainable growth rate formula.
Everyone agrees that Medicare's sustainable growth formula has got to
go. Today, we are considering a bill to realistically accomplish that
goal.
The SGR formula was enacted as part of the Balanced Budget Act of
1997 in an attempt to restrain Federal spending in Medicare part B. We
now know that that is not working.
The SGR consists of expenditure targets which apply a growth rate
designed to bring spending in line.
Since 2002, the SGR formula has resulted in a reduction in physician
reimbursement rates. However, even though Congress has consistently
passed legislation to override the formula, these patches have resulted
in hundreds of billions of spent funds that could have gone to
improving the Medicare system.
If Congress were to let the formula continue, physicians would face a
21 percent reduction in reimbursement rates on April 1. The sustainable
growth rate's unrealistic assumptions of spending inefficiency have
plagued the healthcare profession and our Medicare beneficiaries for
over 13 years.
The bill before us repeals the sustainable growth rate formula,
avoiding potentially devastating across-the-board cuts slated to go
into effect next week. We do so at a cost lower than what Congress has
already spent or is likely to spend over the next 10 years. The
Congressional Budget Office has found that enacting H.R. 2 will cost
less than if we patched this formula over the next 10 years.
The bill before us today provides 5 years of payment transition. It
allows improved beneficiary access and allows medicine to concentrate
on moving to broad adoption of quality reporting and, most importantly,
allows Congress to move past the distraction of the SGR formula and to
begin identifying Medicare reforms that can further benefit our
citizens. This will also allow providers the time to develop and test
quality measures and clinical practice improvement activities, which
will be used for performance assessment during phase II.
During the stability period, physicians will receive annual increases
of one half of 1 percent. It seems small, but it is above what has been
provided over the past several years.
The quality measures are implemented in what is called the Merit-
Based Incentive Payment System. That will be evidence-based and
developed through a transparent process that values input from provider
groups. Quality reporting will measure providers against their peers
rather than a one-size-fits-all generic standard. Providers will also
self-determine their measures.
The bill consolidates three reporting programs into this incentive
payment system, easing administrative burdens and furthering the
congressionally established goals of quality, resource use, and
meaningful use.
This new reimbursement structure ensures continued access to high-
quality care while providing physicians with certainty and security in
their reimbursements. They will be aware of the benchmark they are
competing against and, unlike current law, all penalties assessed on
those not meeting the benchmark will go to those who do, keeping the
dollars in the Medicare system.
Provider standards will be developed by professional organizations in
conjunction with existing programs and will incorporate ongoing
feedback to physicians, further ensuring that optimal care is provided
to the patient.
Realtime feedback will be gained through registries and performance
data. Physicians will be encouraged to participate in the process
through data reporting. For eligible professionals who choose to opt
out of the fee-for-service program, alternative payment models will be
available.
These alternative payment models may include a patient-centered
medical home, whether they are in primary or specialty care, bundled
care, or episodes of care. Qualifying practices that move a significant
amount of their patients into these alternative payment models could
see a 5 percent quality bonus. By encouraging alternative payment
models and care coordination, this legislation will foster and
facilitate innovation.
It is important to note that while taking these important steps
toward ensuring quality care, the bill specifically states that these
quality measures are not creating a Federal right of action or a legal
standard of care.
Mr. Speaker, from beginning to end, this bill is about access: access
for our seniors, access for those who utilize the Nation's 9,000
community health centers, and, very importantly, the over 8 million
children who receive their care at some point during the year through
the Children's Health Insurance Program.
The bill also addresses health programs that have become known as
``extenders.'' Most are extended for 2 years under the bill. By
resolving the SGR, Congress will have the ability to commit itself to
working through these policies in the future.
The bill also puts into place important structural reforms to
Medicare that are the first steps toward starting the Medicare program
on a really long-term trajectory towards fiscal stability.
The bill is consistent in its themes throughout: payment stability;
reduce
[[Page H2040]]
and streamline the administrative burden; increase predictability and
provider's interactions with the Centers for Medicare and Medicaid
Services; build transparency into systems; encourage innovation of
delivery of services; and keep providers in the driver's seat.
Most importantly, we provide access to care for our Nation's
patients.
America's providers agree:
``The American Osteopathic Association views this bipartisan
legislation as a clear and definitive approach toward comprehensive
reforms in our health care system for children, seniors, and our
Nation's physicians.''
Here is one from the American Academy of Family Physicians:
``This legislation is the result of bipartisan negotiations that have
produced legislative responses to some of our Nation's most pressing
health care issues.''
America's Essential Hospitals praised this bill, stating:
``This legislation represents the first truly bipartisan major health
care legislation in years. Please do not let this opportunity pass you
by--approve H.R. 2 as swiftly as possible.''
This is just a small sampling of the close to 800 organizations
spanning the political spectrum who have come together to endorse this
bill. From primary care, to specialists, to surgeons, to organized
nursing, our Nation's hospitals, and everyone in between, they have
supported this policy.
For that reason, I encourage my colleagues to vote ``yes'' on the
rule and ``yes'' on the underlying bills.
I reserve the balance of my time.
Mr. McGOVERN. Mr. Speaker, I yield myself such time as I may consume.
(Mr. McGOVERN asked and was given permission to revise and extend his
remarks.)
Mr. McGOVERN. Mr. Speaker, I want to thank the gentleman from Texas
(Mr. Burgess) for the customary 30 minutes. I also want to thank him
for his work on this legislation.
Mr. Speaker, for far too long, Congress has shirked its
responsibility when it came to permanently fixing the sustainable
growth rate formula. Since its inception, our Nation's doctors and
hospitals were held hostage to a misguided funding formula that was
included as part of the Balanced Budget Act of 1997.
I voted against the Balanced Budget Act back then when I was a new
Member of Congress. It was plain to me that the Medicare cuts and
proposed financing included in that bill were simply impossible to
sustain. I am glad that 18 years later Congress is finally doing the
right thing and repealing the sustainable growth rate formula and
replacing it with a payment system based on value.
It is past time that we repeal this misguided formula that has
wreaked havoc throughout our healthcare system. Year after year after
year, Congress, whether controlled by Democrats or Republicans, was
forced to temporarily patch this formula. And year after year after
year, Congress did the bare minimum, providing a temporary fix without
actually addressing the real problem and permanently repealing the
formula.
Today, Congress is finally doing the right thing. That alone is worth
supporting. But this bill does more than just repeal the sustainable
growth rate formula. Instead, it provides a clearly defined schedule of
payment adjustments that will give physicians and healthcare providers
the stability they need while ensuring quality and value in the
services patients require.
In addition, H.R. 2 also provides critical funding through September
2017 for our Nation's community health centers, funding that was
initially provided under the Affordable Care Act, and it also provides
support for the Children's Health Insurance Program, or CHIP.
I have already started to hear from hospitals in my district about
why this bill is good for them and good for their patients. UMass
Memorial Medical Center, in my hometown of Worcester, is one of the
Nation's most distinguished academic healthcare systems and is the
safety net hospital for all of central Massachusetts. The folks there
are pleased to see the delay in additional cuts to safety net hospitals
and the delay in the implementation of the two-midnight rule.
Now, this bill is not perfect--nothing around here is ever perfect--
but this is the result of long and careful bipartisan negotiation. Even
though there are many very positive aspects of this bill, there are
some provisions that are more problematic, and I would be remiss if I
didn't at least mention some of them.
Most troubling is the inclusion of the Hyde amendment and its
application to the funding for the community health centers. It is
important to clarify that this language is not a permanent extension or
codification of the Hyde amendment. It only applies to the funding for
community health centers and expires when that funding expires. It does
not affect non-Federal funds. In fact, it is the same language that has
been included in annual appropriations bills for nearly three decades.
Let me be clear: I do not support the Hyde amendment. However, the
language in this bill mirrors both President Obama's executive order
and the language included in the annual appropriations bills.
And I wish the CHIP extension was for 4 years rather than 2. But in
this environment, I think that having a 2-year extension is a good
thing, is an accomplishment, is a step in the right direction.
Mr. Speaker, this is an important accomplishment, and I want to thank
both Speaker Boehner and Leader Pelosi for their work in reaching this
compromise, a deal that will finally enable this House to move away
from annual doc-fix patches and toward providing stability and
certainty for Medicare physicians and patients.
I am encouraged by the process taken to reach this agreement. For a
Congress that I might say accurately has been called ``broken,''
``hopeless,'' ``helpless''--a Congress plagued by gridlock and extreme
partisanship--this bill represents what I hope will be a renewed
commitment by my friends in the majority to work across the aisle with
Democrats to address some of our country's most pressing issues. It is,
and has always been, the way Congress passes important, substantive,
and even historic legislation.
This place can work when we work together. Just look at what this
House has done over the past few weeks. We responsibly kept the
Department of Homeland Security open, and now we are on the verge of
passing an incredibly vital bipartisan bill to repeal the sustainable
growth rate, fund community health centers, and reauthorize CHIP.
I hope this bipartisan approach is contagious. I hope this is not the
exception but becomes the rule. Every Member represents the same number
of constituents, and every voice in this House needs and deserves to be
heard.
Today--thanks to the leadership of Leader Pelosi and Speaker Boehner
and so many others--we are doing something that we can feel good about,
something more than a campaign slogan, something that is more than red
meat for the political base.
{time} 0930
This is something that will help seniors, kids, and low-income
families. It deserves our support.
Before I reserve my time, Mr. Speaker, I include for the Record the
Statement of Administration Policy, which begins with the following:
``The Administration supports House passage of H.R. 2 because it
would reform the flawed Medicare physician payment system to
incentivize quality and value'' and ``would make reforms that could
help slow health care cost growth, and would extend other important
programs such as health care coverage for children.''
Statement of Administration Policy
h.r. 2--medicare access and chip reauthorization act
(Rep. Burgess, R-Texas, and 10 cosponsors)
The Administration supports House passage of H.R. 2 because
it would reform the flawed Medicare physician payment system
to incentivize quality and value (a proposal called for in
the President's Fiscal Year 2016 Budget), would make reforms
that could help slow health care cost growth, and would
extend other important programs such as health care coverage
for children.
Medicare payments to physicians are determined under a
formula, commonly referred to as the ``sustainable growth
rate'' (SGR). This formula has called for reductions in
physician payment rates since 2002, which the Congress has
overridden 17 times. Under the SGR, physician payment rates
would be reduced by about 21 percent on April 1, 2015. A cut
of this magnitude could
[[Page H2041]]
reduce access to physicians for Medicare beneficiaries
throughout the country. H.R. 2 would replace this system with
one that offers predictability and accelerates participation
in alternative payment models that encourage quality and
efficiency. The proposal would advance the Administration's
goal of moving the Nation's health care delivery system
toward one that achieves better care, smarter spending, and
healthier people through the expansion of new health care
payment models, which could contribute to slowing long-term
health care cost growth.
The Administration also supports the legislation's
inclusion of a continuation of policies and funding for the
Children's Health Insurance Program (CHIP). The President's
Budget includes a four-year extension of this program, which
has provided meaningful health coverage to over eight million
children; extending CHIP would ensure continued,
comprehensive, affordable coverage for these children. H.R. 2
also includes other important proposals in the President's
Budget, such as an extension of the Home Visiting Program and
additional funding for the Community Health Center (CHC)
Fund, although the legislation includes restrictions on the
use of the CHC Fund which would be unnecessary given
Executive Order 13535. The Administration supports the
legislation's provision to make permanent the Qualifying
Individual program, which pays the Medicare Part B premiums
for certain low-income Medicare beneficiaries.
The legislation would pay for costs above what is needed to
hold Medicare payments to physicians fixed at their current
level. The savings would come from sensible reforms, which
are expected to cover a larger share of the bill's costs over
the long run. These include cost-saving changes to Medicare
provider payments as well as increases in the income-related
premium for certain high-income Medicare beneficiaries, who
represent about five percent of those covered by Medicare. A
similar proposal was included in the President's Budget to
help improve the financial stability of the Medicare program
by reducing the Federal subsidy of Medicare costs for those
who need the subsidy the least. The bill also would, starting
in 2020, prohibit Medicare Supplemental Insurance (Medigap)
policies from covering the Part B deductible (currently $147)
for new beneficiaries. This would encourage more efficient
health care choices, lowering Medicare costs and Medigap
premiums.
Mr. McGOVERN. Mr. Speaker, I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from
Louisiana (Mr. Fleming).
Mr. FLEMING. I would like to thank my good friend, Dr. Burgess.
Mr. Speaker, I rise in support of H.R. 2. As a family physician who
has been in private practice since 1982, I have seen a lot of things
happen with Medicare, and this idea of sustainable growth rate, SGR,
which came up in 1997--a Republican idea--is not only flawed, it is
idiotic.
It requires physicians to control throughout the country the entire
volume of services provided, something that is absolutely impossible to
do. It actually has had the opposite effect that was desired, and it
has actually increased the amount of activity because of the loss of
the valuable economic foundations that are necessary to make this
system work.
What this repeal of SGR will do is, number one, actually show what
the cost of this is. We have been hiding it, like a shell game, for
years with temporary patches that last, oh, maybe a year and sometimes
less.
Not only will this pay for itself in the second decade, but it
actually begins to lower that cost even in the first decade, and it
does so by using several mechanisms but with two important reforms that
my colleagues need to know about.
One, it reforms Medigap policies, which gives patients skin in the
game. It makes patients, once again, a part of the decision team so
that they, by having some element of price sensitivity, can work with
the doctors to decide what is necessary and what is not, what is
affordable and what is not; also, it asks higher-income seniors to do
their share.
Remember that the current Medicare system is a highly subsidized
system for everybody, including for Warren Buffett, a $40 billion
billionaire who gets his health care subsidized.
I urge my colleagues to support this. This will increase patient
care.
Mr. McGOVERN. Mr. Speaker, I yield 2 minutes to the gentleman from
California (Mr. Bera).
Mr. BERA. I want to thank my colleague from Massachusetts for
yielding me this time.
Mr. Speaker, as a doctor who has cared for hundreds of seniors on
Medicare, this is an important step forward because, for over a decade,
we have had this flawed formula that has put the security of seniors'
health care access at risk.
I want to applaud Dr. Burgess, and I want to applaud the bipartisan
Doctors Caucus. You will hear from a lot of doctors here in Congress
that this is a step forward because, when we took our oath to practice
medicine, we took an oath to put our patients first.
This is a good bill that puts our patients first: our seniors, folks
who have worked their whole lives and who now, in retirement, need that
security of being able to see their doctors. This bill repeals a flawed
formula that has been patched 17 times over the years, and it replaces
it with a better formula, a formula that moves us away from this fee-
for-service model and that moves us toward practicing higher quality
care and putting our patients first.
It is not a perfect bill. Like many, I am disappointed to see the
Hyde amendment included in this bill. I have always stood against the
Hyde amendment and against other attempts to restrict a woman's right
to make her own reproductive health decisions.
The Hyde amendment is a temporary rider that expires every year; and
we, along with many women across this country, look forward to the day
when it will end. I came to Congress to put people first. I came to
Congress to work across the aisle in a bipartisan way and to put our
country first, and this is a great attempt.
Again, I applaud the doctors in Congress. I applaud the members of
the Energy and Commerce Committee, the members of the Ways and Means
Committee, the Speaker, and the leader of the Democratic Party here in
the House for working together to put people first.
This is a good bill as 7.4 million patients will still have access to
care at community health centers, 8 million low-income children and
pregnant women will still have access to care through the CHIP program,
49 million patients are enrolled in Medicare, and another 10,000 baby
boomers enroll every day. This is a good thing.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. McGOVERN. I yield the gentleman an additional 1 minute.
Mr. BERA. Mr. Speaker, we have got to honor the promises that we have
made to our constituents and to the people of America. We have got to
honor the promises that we have made to our patients and doctors. This
is a good bill.
I look forward to voting for and passing this bill today and to
continuing to move America forward.
Mr. BURGESS. Mr. Speaker, I yield 1 minute to the gentleman from
Michigan (Mr. Benishek).
Mr. BENISHEK. Thank you, Mr. Chairman. Thank you for all of your good
work on this piece of legislation.
Mr. Speaker, I rise in support of the rule for H.R. 2.
Since the current flawed Medicare payment rate was enacted in 1997,
Congress has kicked the can down the road and has passed 17 different
patches to avoid devastating cuts to Medicare. These patches have cost
the taxpayers almost $170 billion, more money than it will cost to
permanently fix this problem right now.
Today, we have the opportunity to actually fix a major problem and
pass meaningful legislation that will help keep Medicare solvent and
ensure that seniors are able to get the medical care they deserve.
As a doctor who has taken care of patients in northern Michigan for
over 30 years, I know how terrible it would be if we failed to act
today and how seniors would bear the brunt of that failure. Today's
legislation may not be perfect; it is a bipartisan compromise that will
ensure that Medicare continues to provide necessary health care for my
constituents in northern Michigan.
I urge all of my colleagues to support this commonsense and long
overdue fix.
Mr. McGOVERN. Mr. Speaker, I yield 2 minutes to the gentleman from
California (Mr. Aguilar).
Mr. AGUILAR. I want to thank the gentleman from Massachusetts.
Mr. Speaker, this bipartisan compromise that we will address this
afternoon over SGR will strengthen Medicare by lowering costs and by
ensuring that seniors have the doctors of their choice. While this
agreement has important provisions, including critical
[[Page H2042]]
programs to help low-income seniors, families, and children, it does
fall short in a few ways.
As a member of the Pro-Choice Caucus, I am disappointed that this
deal both ignores the need for women to have access to their healthcare
providers and that it includes an antichoice provision. Today's bill
falls short of measures to increase women's access to necessary health
measures, such as annual exams or prescription medications.
The other troubling aspect of today's bill is the inclusion of the
Hyde amendment, as the gentleman from Massachusetts mentioned. This is
clearly another attack to block access to reproductive care. The
inclusion of this language is disappointing because it permits
antichoice language in an otherwise pragmatic, bipartisan compromise in
exchange for community health center funding.
I plan to support this bipartisan compromise because it solves
longstanding problems and is a step in the right direction.
Mr. BURGESS. Mr. Speaker, may I inquire as to the time remaining?
The SPEAKER pro tempore. The gentleman from Texas has 18\1/2\ minutes
remaining, and the gentleman from Massachusetts has 21 minutes
remaining.
Mr. BURGESS. Mr. Speaker, I yield 3 minutes to the gentlewoman from
California (Mrs. Mimi Walters).
Mrs. MIMI WALTERS of California. Mr. Speaker, I rise today in support
of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which is a
bill to repeal and replace the sustainable growth rate.
This bill presents an historic opportunity for Congress to end the
doc fix and comprehensively reform the Medicare physician payment
system once and for all. SGR has been broken for over a decade, and
Congress has passed a temporary patch for this law 17 times. The price
of putting off a permanent fix has cost the taxpayers almost $170
billion and has masked the insolvency of Medicare.
According to the nonpartisan Congressional Budget Office, Mr.
Burgess' legislation to repeal SGR would save $900 million over the
next decade, compared to freezing payment rates for physician services.
After a decade of Congress patching the flawed SGR formula, it is
finally time to permanently repeal and replace the system once and for
all. I urge my colleagues in the House and in the Senate to pass this
bill and finally fix the doc fix.
Mr. McGOVERN. Mr. Speaker, I include the following statements for the
Record in support of H.R. 2: the statement by the Massachusetts
Hospital Association, a statement by the Massachusetts Medical Society,
a list of a number of groups in support of H.R. 2, statements by the
American Hospital Association, SEIU, and others. They are all in
support of this bill.
Massachusetts Hospital Association (MHA) Statement on H.R. 2
March 25, 2015
The Massachusetts Hospital Association gives its full
support to H.R. 2, the U.S. House bipartisan package to
permanently repeal the Medicare physician Sustainable Growth
Rate (SGR).
We are especially relieved because there have been 17
short-term SGR fixes over the past few years, nearly all of
which included significant reimbursement cuts to hospitals
and other providers for nothing more than a couple-month band
aid. This bill draws these short term patches to an end. We
are relieved that Children's Health Insurance Program (CHIP)
funding, community health center funding, and a continued
delay to enforcement of the two-midnight rule are included.
We support the bill not only for what it does, but also for
what it does not do; it rejects cuts to graduate medical
education, Medicare bad debt, site neutral cuts to hospital
outpatient departments and inpatient rehabilitation
facilities, and it does not include unsound and inequitable
area wage index and rural floor policies.
Obviously, we would prefer not to be part of the offsets to
help pay for the package, but we are realistic and especially
so because we realize that if this deal falls through and
Congress must consider another one-year SGR delay, then these
cuts to providers will still be in play to pay for a
meaningless, additional one-year delay. We strongly prefer a
permanent SGR fix and therefore give our full support to this
bill.
Most importantly, we thank our congressional delegation for
their efforts on behalf of hospitals. Given the political
environment that has been a barrier to collaboration on major
legislation, this bill represents an exceptional
accomplishment that benefits hospitals, physicians, other
providers, and most notably, the long term health of the
Medicare program.
____
Massachusetts Medical Society,
Waltham, MA, March 25, 2015.
Hon. James P. McGovern,
Cannon House Office Building,
Washington, DC.
Dear Representative McGovern: I am writing you as President
of the Massachusetts Medical Society to urge you to vote in
support of HR 2, the Medicare Access and CHIP Reauthorization
Act. Your support for this legislation will be critical to
its success and our members' ability to continue to treat
Medicare and Tricare patients who need and deserve quality
health care. Moreover this bill will continue funding for the
CHIP program at increased levels for two years and provide
necessary funds for our Community Health Centers, a vital
component of our health care system.
We have been extremely grateful for your ongoing support
for SGR reforms in the past. As you are well aware, Congress
has passed 17 temporary measures which ultimately have cost
the government more money than a permanent solution. We
believe the time has finally come to pass permanent Medicare
physician payment reform.
The importance of the SGR reforms extends well beyond the
26,000 members of the Massachusetts Medical Society. It will
impact the nearly 71,597 military families who receive their
health insurance through Tricare, the 74,525 people employed
by physicians and the over 1,104,483 Medicare beneficiaries
who live in the Commonwealth. This bill will also impact
every hospital in the state that employs physicians, every
medical device manufacturer who sells products to physicians'
offices and the myriad of organizations that rely on Medicare
dollars. This bill is about ensuring seniors and military
families' access to care. It is about sustaining physician
practices. Of equal importance, this legislation will
significantly foster and reward changes in the health care
delivery system that we all hope to achieve.
We also strongly support provisions reauthorizing the CHIP
program. The MMS has been a strong supporter of this program
since its inception. This legislation provides an opportunity
for Congress to address the health care needs of children and
low-income Americans by extending funding for the Children's
Health Insurance Program and providing critical support for
Community Health Centers. We believe a straightforward 2 year
reauthorization of the CHIP program at the 23% increased
rates set by the ACA would be critically important to the
patients served by this program. Should the program not be
reauthorized at these levels it is estimated that
Massachusetts could lose millions of dollars--funds that this
state desperately needs.
We knew that passage of final SGR repeal would never be
easy. But we are truly at that point where we believe the
leadership has developed a SGR strategy that is achievable.
As President of the Massachusetts Medical Society I want to
thank you for your ongoing support for Medicare payment
reform and urge you to continue your support by voting for HR
2 when it comes to the House floor.
Sincerely,
Richard S. Pieters, M.D.
____
Some of the Groups Supporting H.R. 2, Medicare Access and CHIP
Reauthorization Act of 2015
Center for American Progress, Families USA, Center on
Budget and Policy Priorities, Center for Law and Social
Policy (CLASP), National Coalition on Health Care (coalition
of over 80 groups), Healthcare Leadership Council, March of
Dimes, JDRF (Juvenile Diabetes), Georgetown Center for
Children and Families, National Association of Community
Health Centers, Third Way, Bipartisan Policy Center, American
Medical Association, American College of Physicians, American
College of Surgeons, American College of Cardiology, American
Congress of Obstetricians and Gynecologists, American Academy
of Pediatrics, American Osteopathic Association, American
Academy of Family Physicians.
American College of Allergy, Asthma and Immunology,
American Association of Medical Colleges, Digestive Health
Physicians Association, American College of Radiology,
Council of Academic Family Medicine, American Society of
Cataract and Refractive Surgery, American Hospital
Association, Federation of American Hospitals, America's
Essential Hospitals, Children's Hospital Association,
Catholic Health Association of the United States, American
Health Care Association, National Center for Assisted Living.
American Nurses Association, American Association of
Colleges of Nursing, American Association of Nurse
Practitioners, American Association of Nurse Anesthetists,
American College of Nurse-Midwives, Gerontological Advance
Practice Nurses Association, National Association of Clinical
Nurse Specialists, National Association of Nurse
Practitioners in Women's Health, Medical Group Management
Association, Premier healthcare alliance, VHA Inc., LUGPA
(Large Urology Group Practice Association), National
Association of Psychiatric Health Systems, National Retail
Federation.
[[Page H2043]]
____
American Hospital Association,
Washington, DC, March 24, 2015.
U.S. House of Representatives,
Washington, DC.
Dear Member of Congress: On behalf of the nearly 5,000
members of the American Hospital Association, I am writing to
express our support for H.R. 2, bipartisan legislation to
repeal the flawed Sustainable Growth Rate (SGR) formula for
physician payments under the Medicare program. We believe
Congress should move forward and address this issue on a
permanent basis.
While we are disappointed that hospitals would be looked to
as an offset given that Medicare already pays less than the
cost of delivering services to beneficiaries, the package
strikes a careful balance in the way it funds the SGR repeal
and embraces a number of structural reforms to the Medicare
program. Equally important, the legislation rejects a number
of flawed policy options, including reductions to outpatient
hospital services (so-called ``site-neutral'' cuts), Medicare
bad debt payments, graduate medical education, critical
access hospitals and certain services provided in
rehabilitative hospitals. Moreover, the bill rejects a
further delay in the ICD-10 program, and prevents a potential
0.55 percent coding offset previously proposed by the Centers
for Medicare & Medicaid Services. The legislation also
eliminates cuts to the Medicaid Disproportionate Share
Hospital program in fiscal year 2017. Finally, the bill
includes a needed extension of a number of expiring provision
(so-called extenders), including the Medicare Dependent
Hospital program, the rural low-volume adjustment, the rural
ambulance add-on, the partial enforcement delay on Medicare's
``two-midnight'' policy, and the Children's Health Insurance
Program.
We commend the House Republican and Democratic leadership
in their design of this package, and urge the House to pass
it.
Sincerely,
Rich Umbdenstock,
President and CEO.
____
SEIU,
March 25, 2015.
Dear Representative, The Service Employees International
Union (SEIU) expresses its support for H.R. 2, legislation
that would permanently replace the Sustainable Growth Rate
(SGR) formula used to determine Medicare payments to doctors.
We appreciate the bipartisan negotiations that led to this
compromise, and, at this point in the process, urge House
members to vote yes to move the process forward.
Tens of millions of Americans, and approximately one
million of SEIU members, have jobs that depend on a strong
health care economy, and many work in environments that face
considerable strains as a result of the uncertainty created
by the SGR. For example, due to short-term SGR patches,
hospitals face the threat of problematic payment changes
every several months, creating an unpredictable landscape
that adversely affects the ability of hospitals to provide
care as well as their ability to support the health care
workforce. Long-term, the pressure that the SGR creates will
continue to grow because the cost of replacing the policy, in
both patches and in its entirety, only increases radically
over time. H.R. 2 permanently replaces the SGR formula,
offsetting $70 billion in costs, preventing significantly
higher and potentially more harmful cuts to Medicare and
other health care programs now and in the future.
In addition to relieving the burden that the costs of SGR
patches and replacement place on the health care system, this
legislation extends, and in some case makes permanent,
programs that are essential to low- and moderate-income
families. H.R. 2 extends full funding under current law for
the Children's Health Insurance Program (CHIP) for an
additional two years. CHIP funding is set to expire in
September 2015. Millions of families, including those of our
members, depend on CHIP to provide health care coverage for
their children. Though we support extending CHIP funding
under current law for four years, extending CHIP funding
under current law for two years does provide predictability
that states need to appropriately administer the program and
prevents problematic changes in eligibility and coverage that
would limit access to care or increase costs for the CHIP
population. In addition, this legislation provides an
additional funding for Community Health Centers, a critically
important source of health care for millions of families.
Finally, the legislation makes permanent the Qualifying
Individual (QI) program, which covers the cost of Medicare
Part B premiums for low-income people with Medicare, and the
Transitional Medicaid Assistance (TMA) program, which
supports families losing coverage. These important programs
that protect low-income populations are set to expire and,
without passage of this legislation, face an uncertain
future, as historically they have been extended only on a
temporary basis.
Like any compromise, this package has serious flaws. As
previously stated, House Republican leaders should have
agreed to fund CHIP under current law for an additional four
years and should not have required changes to Medicare
benefits in order to reach an agreement. While some of the
changes to Medicare are mitigated because they only apply to
consumers with truly higher incomes, we have concerns about
the precedents set by these changes and changes to Medigap
coverage policies. In addition, we continue to oppose any
language that expands policies that deny millions of women
the right to access the full range of reproductive health
care services. Lastly, in order to avoid policy changes that
put additional financial burdens on beneficiaries and
providers--who have already faced significant SGR-related
cuts--other stakeholders should have been required to
contribute more in terms of offsets. However, despite these
concerns, when considering the potential impact of this
package versus the adverse consequences that non-resolution
of both the SGR and CHIP funding may have on all health
programs and the populations they serve, we believe that this
is an acceptable solution that House members should support.
For these reasons, we urge you to vote yes on this
compromise legislation. If you have any questions, please
call Ilene Stein, SEIU Assistant Legislative Director.
Sincerely,
Mary Kay Henry,
International President.
____
Statement by Senior Fellow Allyson Schwartz, Senior Fellow Dr. Zeke
Emanuel, and Vice President for Health Policy Topher Spiro
The Center for American Progress supports the Medicare
Access and CHIP Reauthorization Act, or MACRA. This
bipartisan legislation represents a significant achievement
because it reforms Medicare's payment system and maintains
critical funding for health care for millions of low-income
children, families, and seniors. While we urge Congress to
offer amendments that would improve the bill, enactment of
this legislation would be far better than resorting to
another short-term fix that could put these programs in
jeopardy. The addition of the Hyde language restricting
abortions is unnecessary and frankly offensive, but we
believe the deal is an important step forward.
Unless Congress extends funding for these programs now,
they will face tremendous uncertainty and risk and could be
held hostage in partisan legislation later in the year. MACRA
addresses this serious risk by including the following:
The bill extends the Children's Health Insurance Program,
or CHIP, for two years. Without this extension, about 2
million children would become uninsured, while millions more
would lose their current coverage and face higher costs.
Importantly, this is a ``clean'' extension that maintains
policies and funding included in the Affordable Care Act--and
that does not include detrimental policies or cuts proposed
by the Republican leadership in Congress. This clean
extension would be a significant feat given the political
realities of this Congress and should not be discounted. Even
so, we strongly urge Congress to amend MACRA to extend CHIP
for at least four years.
The bill extends funding for community health centers
included in the Affordable Care Act. Without this funding,
7.4 million low-income patients--including 4.3 million
women--would lose access to health care. While not a change
to current policy, the bill applies the Hyde Amendment, which
restricts funding for abortions, to this funding. CAP opposes
the Hyde Amendment, which harms low-income women, and
ultimately wants this temporary restriction to expire for
good. The application of the Hyde Amendment is, at best,
unnecessary and, at worst, an indication that Republican
leadership in Congress will attempt to use every bill to
restrict access to abortion, which is unacceptable. In this
case, the offensive language does not change policy and--
similar to the Hyde Amendment that has always applied to
funding for community health centers--is temporary and
expires along with the funding to which it applies. Even so,
we strongly urge Congress to amend MACRA to remove this
language.
The bill extends the Maternal, Infant, and Early Childhood
Home Visiting program for two years. This funding supports
evidence-based programs that have been proven to reduce
health care costs, improve school readiness, and increase
family self-sufficiency and economic security. We strongly
urge Congress to amend MACRA to extend this program for at
least four years.
The bill extends the Qualifying Individual Program--which
subsidizes Medicare premiums for low-income beneficiaries--
permanently.
By permanently correcting Medicare payments to physicians,
MACRA at long last provides much-needed certainty and
stability to the Medicare program. Importantly, the bill
provides financial incentives to reinforce the country's path
toward a health care system that rewards value and quality of
care.
We recognize that any bipartisan compromise that could be
enacted by Congress would need to pay for at least a portion
of the additional spending that would result--and that the
pay-fors would need to include a roughly equal mixture of
cuts to providers and cuts to beneficiaries. We also
recognize that the alternative--a never-ending series of
short-term patches that are fully paid for--would likely
result in deeper and more painful cuts to the Medicare
program over time.
On the beneficiary side, MACRA increases Medicare premiums
by $82.50 per month for couples with incomes from $267,000 to
$428,000 and singles with incomes from $133,500 to $214,000.
Because this premium increase is targeted to the top 2
percent of beneficiaries, it is the least objectionable
beneficiary cut
[[Page H2044]]
that could have been included in such a package. The bill
does not otherwise increase premiums across the board by $58
billion, as some have asserted, compared to premium levels
under current policy.
MACRA's other beneficiary cut causes us more concern.
Currently, about 12 percent of beneficiaries purchase Medigap
supplemental policies to cover their out-of-pocket costs. The
bill prohibits these policies from covering the deductible
for physician services, which is $147 in 2015. The effect of
this change is limited because it goes into effect in 2020
and applies only to new beneficiaries. In addition, because
Medigap policies would no longer cover the deductible,
premiums for these policies would go down. For most affected
beneficiaries, the savings from lower Medigap premiums would
actually exceed the costs from deductibles. However, it is
possible that hundreds of thousands of beneficiaries with
incomes below 300 percent of the federal poverty line would
face net costs of less than $100 per year. We strongly urge
Congress to amend MACRA to protect low-income beneficiaries
from this change--either by exempting primary care from their
deductibles or by expanding cost-sharing subsidies for this
targeted group.
While we would like to see this legislation strengthened,
as we have recommended above, this compromise legislation
takes an important step in Medicare payment reform and
ensures continued funding that improves the health and
welfare of millions of children, families, and seniors. We
urge Congress to enact it.
____
BPC Urges Congress to Pass Legislation to Reform Medicare and Extend
Children's Health Insurance
[Press Release, March 25, 2015]
Washington, DC.--The Bipartisan Policy Center (BPC) issued
the following statement by BPC President Jason Grumet; Senior
Vice President Bill Hoagland; and Health Policy Director
Katherine Hayes regarding the Medicare Access and CHIP
Reauthorization Act of 2015:
``We urge Congress to act swiftly to pass H.R. 2, the
Medicare Access and CHIP Reauthorization Act introduced this
week by chairmen and ranking members of the House Energy &
Commerce and Ways & Means Committees. This bill would
permanently replace Medicare's sustainable growth rate (SGR)
physician payment system, extend funding for the State
Children's Health Insurance Program (CHIP), and implement
structural reforms in Medicare to improve care delivery and
slow rising costs.
``Like any good bipartisan compromise, this legislation
strikes a careful balance that will draw both praise and
criticism. By reconciling these competing views, the proposed
legislation offers a set of politically viable solutions that
deserve broad bipartisan support.
``A permanent SGR repeal--coupled with new incentives to
improve quality and value in Medicare--would end the
senseless perennial series of temporary patches to prevent
payment cuts to physicians; it would also enable Congress to
move forward on a broader set of reforms.
``A two-year extension of full CHIP funding with no
programmatic changes, would provide near-term certainty to
states and low-income families who rely upon this essential
program.
``A balanced package of policy `offsets'--including cuts
from providers and 2% of high-income seniors--would pay for a
significant portion of the legislation. Additional savings
from improved Medicare payment incentives may accrue over the
long term.
``A provision to make permanent the Medicare Qualifying
Individual program would provide extra help to lower income
seniors in paying their Medicare Part B premiums.
``We urge U.S. Senators and House members to act now to
extend and improve these critical programs for our nation's
seniors, children, and health care providers.''
Mr. McGOVERN. Mr. Speaker, as I said, it is not a perfect bill, but
it represents, I think, a major accomplishment.
If I could inquire of the gentleman as to how many additional
speakers he has.
Mr. BURGESS. Mr. Speaker, we have no additional speakers at this
time. I am prepared to close after the gentleman closes.
Mr. McGOVERN. I yield myself the balance of my time, and I will take
this opportunity to close my side of the debate, Mr. Speaker.
Mr. Speaker, let me begin by thanking all of those who have been
involved in this compromise, especially Speaker Boehner and Leader
Pelosi. I want to thank Mr. Burgess. I want to thank all of the members
of the Energy and Commerce Committee. I am grateful to the staffs of
all of the relevant committees for all of the work that they have put
into this.
I especially want to acknowledge the incredible work of the staff who
works in the Office of Legislative Counsel. They don't always get
thanked, but they do so much of the work around here, not only on
important and complicated legislation like what we are debating here
today, but on all legislation, so we are grateful to them.
I don't really know what else to say here except that I am happy we
are doing something, and I am happy that we are actually putting
forward a bill, a bipartisan bill, that will help a lot of the people
who most need help.
As Mr. Burgess said, in reality, this bill is about access, making
sure our senior citizens have the access to the doctors and to the
health care that they want. We are making that possible through this
bill, as well as helping countless children and low-income families and
supporting our community health centers.
This has been kind of an incredible week. It is hard to believe.
First, we read that Ted Cruz signs up for ObamaCare, and now, we have
this bipartisan compromise on the doc fix, and it reauthorizes CHIP and
provides money to our community health centers.
Who knows. I mean, if this is contagious, maybe next week, we will
deal with climate change, so I am feeling good as we close this week.
Again, I hope this is a coming attraction of what we can see in the
future: more bipartisan cooperation, more give and take.
If we follow what we did here, we actually can accomplish a lot more
for the American people, and I think that would be a good thing.
Let's get this done.
I yield back the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time.
Today's rule provides for the consideration of legislation addressing
the pernicious sustainable growth rate formula, the most threatening
issue in Medicare, risking patient access to care for our seniors.
As I close, I would like to note that each committee's work is
represented in H.R. 2. The base policy of H.R. 2 has the backing of the
House and Senate negotiators and of all three committees of
jurisdiction.
I certainly want to thank the Speaker and the minority leader and
their staffs for building off of the policy work accomplished by the
committees to present a political pathway forward for this bipartisan
bill.
I thank the chairmen and ranking members of the House Committees on
Energy and Commerce and Ways and Means, as well as of the Senate
Finance Committee, for coming together for our Nation's doctors and
seniors.
I must note Chairman Upton, Chairman Pitts, Chairman Ryan, Chairman
Brady, and former Chairman Camp, as well as Ranking Members Pallone,
Gene Green, Sander Levin, Jim McDermott, and former Ranking Member
Henry Waxman.
I would also like to thank all of the staffs who have worked on this
issue--who have labored on this issue--for years. I know I will miss
some people, but I do want to mention a few at the committee level who
have dedicated themselves to getting us here today.
{time} 0945
=========================== NOTE ===========================
March 26, 2015, on page H2044, the following appeared:themselves
to getting us here today. 0930 Some have left or switched their
The online version should be corrected to read:themselves to
getting us here today. 0945 Some have left or switched their
========================= END NOTE =========================
Some have left or switched their roles, but their work from the
beginning deserves recognition. Certainly I want to thank Clay Alspach,
Robert Horne, Ryan Long, Dr. John O'Shea, Dr. Steve Ferrara, Amy Hall,
Eddie Garcia, Tiffany Guarascio, Arielle Woronoff, Brett Baker, Brian
Sutter, Matt Hoffmann, Erin Richardson, and J. P. Paluskiewicz on my
staff.
I also want to thank the unsung heroes at the House Legislative
Counsel, namely, Jessica Shapiro, Ed Grossman, and Jesse Cross.
Every success we have had at each point in this process was further
than we had ever come before, and that involved a lot of work, a lot of
negotiation, and a lot of overwhelming desire to see the process
through to the end.
Ultimately, if this is a package that can go to the White House, all
of this will be worth it. I certainly do look forward to passage and
hope that, given the positive signs evidenced over the past several
days, the other Chamber will quickly embrace this package and
ultimately get this badly needed policy into law.
I certainly want my colleagues to support both the rule and the
underlying bill.
Ms. SLAUGHTER. Mr. Speaker, I rise today in support of H.R. 2, the
Medicare Access and CHIP Reauthorization Act. This bill funds Community
Health Centers for two years at $7.2 billion dollars. These community
health centers serve many of the newly insured people in my district.
Thanks to the Affordable
[[Page H2045]]
Care Act, they have health insurance, but thanks to community health
centers, they have health care.
H.R. 2 also extends the CHIP program and keeps over 8 million low-
income children and pregnant women in families from losing their health
insurance.
Lastly, H.R. 2 finally fixes the SGR, the Medicare Sustainable Growth
Rate. The SGR was an ill-conceived plan to control the growth in health
care costs by slashing doctor pay. We were in danger of doctors
dropping Medicare patients, putting seniors' access to critical medical
care at risk. The yearly short-term fixes have cost us more over the
years than it would have to get rid of it, so I am pleased we are
finally doing the right thing today in a way that moves us toward
quality health care for Americans.
Mr. Speaker, I'd like to take this opportunity to clarify a provision
in H.R. 2 and how it differs from S. 178--the Senate Justice for
Victims of Trafficking Act of 2015 (JVTA).
As you know, the Senate is having a debate about a provision to make
the Hyde Amendment part of permanent law and to apply it to non-
taxpayer funds. As co-chair of the Pro Choice Caucus, I want to make
this clear: the Senate bill creates a new Domestic Trafficking Victims'
Fund that would be funded--not by taxpayer dollars--but through fines
imposed on defendants convicted of human trafficking, sexual
exploitation and human smuggling crimes. The Hyde Amendment only
applies to taxpayer dollars. Hyde Amendment restrictions have never
been applied on a federal fund containing zero taxpayer dollars. This
new fund is not federal dollars and therefore not eligible for Hyde.
The pro-choice senators who are fighting against this expansion have my
full support.
Mr. BURGESS. Mr. Speaker, I yield back the balance of my time, and I
move the previous question on the resolution.
The previous question was ordered.
The SPEAKER pro tempore. The question is on the resolution.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. BURGESS. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The vote was taken by electronic device, and there were--yeas 402,
nays 12, answered ``present'' 5, not voting 13, as follows:
[Roll No. 143]
YEAS--402
Abraham
Adams
Aderholt
Aguilar
Allen
Amodei
Ashford
Babin
Barletta
Barr
Barton
Bass
Beatty
Becerra
Benishek
Bera
Beyer
Bilirakis
Bishop (GA)
Bishop (MI)
Bishop (UT)
Black
Blackburn
Blum
Blumenauer
Bonamici
Bost
Boustany
Boyle, Brendan F.
Brady (PA)
Brady (TX)
Brat
Bridenstine
Brooks (IN)
Brown (FL)
Brownley (CA)
Buchanan
Buck
Bucshon
Burgess
Bustos
Butterfield
Byrne
Calvert
Capps
Capuano
Cardenas
Carney
Carson (IN)
Carter (GA)
Carter (TX)
Cartwright
Castor (FL)
Castro (TX)
Chabot
Chaffetz
Chu, Judy
Clark (MA)
Clarke (NY)
Clawson (FL)
Clay
Cleaver
Clyburn
Coffman
Cohen
Cole
Collins (GA)
Collins (NY)
Comstock
Conaway
Connolly
Cook
Costa
Costello (PA)
Courtney
Cramer
Crawford
Crenshaw
Crowley
Cuellar
Culberson
Cummings
Curbelo (FL)
Davis (CA)
Davis, Danny
Davis, Rodney
DeFazio
DeGette
Delaney
DeLauro
DelBene
Denham
Dent
DeSantis
DeSaulnier
DesJarlais
Deutch
Diaz-Balart
Dingell
Doggett
Dold
Doyle, Michael F.
Duckworth
Duffy
Duncan (SC)
Duncan (TN)
Edwards
Ellison
Ellmers (NC)
Emmer (MN)
Engel
Eshoo
Esty
Farenthold
Farr
Fattah
Fincher
Fitzpatrick
Fleischmann
Fleming
Flores
Forbes
Fortenberry
Foster
Foxx
Frankel (FL)
Frelinghuysen
Fudge
Gabbard
Garamendi
Garrett
Gibbs
Gibson
Gohmert
Goodlatte
Gowdy
Granger
Graves (GA)
Graves (LA)
Graves (MO)
Grayson
Green, Al
Green, Gene
Grijalva
Grothman
Guinta
Guthrie
Gutierrez
Hahn
Hanna
Hardy
Harper
Harris
Hartzler
Hastings
Heck (NV)
Heck (WA)
Hensarling
Herrera Beutler
Hice, Jody B.
Higgins
Hill
Himes
Holding
Honda
Hoyer
Hudson
Huffman
Huizenga (MI)
Hultgren
Hunter
Hurd (TX)
Hurt (VA)
Israel
Issa
Jackson Lee
Jenkins (KS)
Jenkins (WV)
Johnson (OH)
Johnson, E. B.
Johnson, Sam
Jolly
Jordan
Joyce
Kaptur
Katko
Keating
Kelly (IL)
Kelly (PA)
Kennedy
Kildee
Kilmer
Kind
King (IA)
King (NY)
Kinzinger (IL)
Kirkpatrick
Kline
Knight
Kuster
LaMalfa
Lamborn
Lance
Larsen (WA)
Larson (CT)
Latta
Lawrence
Lee
Levin
Lewis
Lieu, Ted
Lipinski
LoBiondo
Loebsack
Lofgren
Long
Loudermilk
Love
Lowenthal
Lowey
Lucas
Luetkemeyer
Lujan Grisham (NM)
Lujan, Ben Ray (NM)
Lummis
Lynch
MacArthur
Maloney, Carolyn
Maloney, Sean
Marchant
Marino
Matsui
McCarthy
McCaul
McClintock
McCollum
McDermott
McGovern
McHenry
McKinley
McMorris Rodgers
McNerney
McSally
Meadows
Meehan
Meng
Messer
Mica
Miller (FL)
Miller (MI)
Moolenaar
Mooney (WV)
Moore
Moulton
Mullin
Murphy (FL)
Murphy (PA)
Nadler
Napolitano
Neal
Neugebauer
Newhouse
Noem
Nolan
Norcross
Nugent
Nunes
O'Rourke
Olson
Pallone
Palmer
Pascrell
Paulsen
Pearce
Pelosi
Perlmutter
Perry
Peters
Peterson
Pingree
Pittenger
Pitts
Pocan
Poe (TX)
Poliquin
Polis
Pompeo
Posey
Price (NC)
Price, Tom
Quigley
Ratcliffe
Reed
Reichert
Renacci
Ribble
Rice (NY)
Rice (SC)
Richmond
Rigell
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rohrabacher
Rokita
Rooney (FL)
Ros-Lehtinen
Roskam
Ross
Rothfus
Rouzer
Roybal-Allard
Royce
Ruppersberger
Rush
Russell
Ryan (OH)
Ryan (WI)
Salmon
Sanchez, Linda T.
Sanchez, Loretta
Sanford
Sarbanes
Scalise
Schakowsky
Schiff
Schock
Schrader
Scott (VA)
Scott, Austin
Scott, David
Sensenbrenner
Serrano
Sessions
Sewell (AL)
Sherman
Shimkus
Shuster
Simpson
Sinema
Sires
Slaughter
Smith (MO)
Smith (NE)
Smith (NJ)
Smith (TX)
Speier
Stefanik
Stewart
Stivers
Swalwell (CA)
Takai
Takano
Thompson (CA)
Thompson (MS)
Thompson (PA)
Thornberry
Tiberi
Tipton
Titus
Torres
Trott
Turner
Upton
Valadao
Van Hollen
Vargas
Veasey
Vela
Velazquez
Visclosky
Wagner
Walberg
Walden
Walker
Walorski
Walters, Mimi
Walz
Wasserman Schultz
Waters, Maxine
Watson Coleman
Weber (TX)
Webster (FL)
Welch
Wenstrup
Westerman
Westmoreland
Whitfield
Williams
Wilson (FL)
Wilson (SC)
Wittman
Womack
Woodall
Yarmuth
Yoder
Yoho
Young (IA)
Young (IN)
Zeldin
Zinke
NAYS--12
Amash
Brooks (AL)
Cicilline
Cooper
Gallego
Graham
Huelskamp
Jones
Massie
Rangel
Tonko
Tsongas
ANSWERED ``PRESENT''--5
Gosar
Griffith
Labrador
Mulvaney
Stutzman
NOT VOTING--13
Conyers
Franks (AZ)
Hinojosa
Jeffries
Johnson (GA)
Langevin
Meeks
Palazzo
Payne
Ruiz
Schweikert
Smith (WA)
Young (AK)
{time} 1011
Mr. AMASH changed his vote from ``yea'' to ``nay.
Messrs. BISHOP of Georgia, WALZ, LOEBSACK, McNERNEY, CAPUANO,
O'ROURKE, HANNA, and SEAN PATRICK MALONEY of New York changed their
vote from ``nay'' to ``yea.''
So the resolution was agreed to.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
Stated for:
Mr. CONYERS. Mr. Speaker, I was not present for rollcall vote No.
143. Had I been present, I would have voted ``aye.''
Ms. TSONGAS. Mr. Speaker, on rollcall vote No. 143, I voted ``no''
and I intended to vote ``yes.''
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