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Providing for Consideration of H.R. 1549, Helping Sick Americans Now Act

Floor Speech

Location: Washington, DC


Mr. BURGESS. Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentlelady from New York (Ms. Slaughter), pending which I yield myself such time as I may consume. During consideration of this resolution, all time yielded is for the purpose of debate only.

House Resolution 175 provides for a structured rule for consideration of H.R. 1549. The rule provides for 1 hour of general debate equally divided by the chair and the ranking member of the Committee on Energy and Commerce.

The rule makes in order two amendments, one Republican, one Democratic, with 10 minutes of debate for each. Further, the rule provides for one motion to recommit with or without instructions.

Mr. Speaker, I rise today in support of the rule and the underlying bill. The underlying legislation is a needed piece of relief for the hundreds of thousands of Americans who were promised by their President that they would be covered under the Affordable Care Act's Preexisting Condition Insurance Plan and then were told, as of February 1 of this year, Sorry, we're closed. This is one of the many promises the President made that he has failed to uphold.

In response to the President's failed promise, Chairman Joe Pitts introduced H.R. 1549, the Helping Sick Americans Act, to continue to provide insurance for those Americans who are most in need of immediate care. And to pay to give those most vulnerable patients insurance and care, we use the Prevention and Public Health Fund, an allocation of money that should be going to help patients, but it's instead being used for administrative costs to set up the exchanges that won't be online for some time now and for glossy brochures to extol their virtues. The money could be used to help people now, and that's why Republicans are here today.

The Affordable Care Act created the new Preexisting Condition Insurance Plan, which was, arguably, duplicative of actions taken by 35 States prior to 2010 that were operating risk pools, that were operating re-insurance programs and served over 200,000 Americans.

It has been shown that State-based programs play an important role in lowering costs across markets and then providing coverage options for those with preexisting conditions. In some States, those plans merged with the Federal plan into an existing high-risk pool. In other States, like Texas, the Federal plan operates in parallel to the State's pool.

But whether the States merged their pools, adopted a State-administered preexisting plan, or whether the Federal preexisting plan is the only option, this program is the only answer for those who have found themselves unable to purchase insurance on their own because of a medical condition.

Shortly after the passage of the Patient Protection and Affordable Care Act, the chief actuary for the Centers for Medicare & Medicaid Services estimated that the creation of this program would result in roughly 375,000 gaining coverage in 2010. However, to date, only 107,000 individuals were enrolled in the program as of January 1 of this year.

On February 15 of this year, the Centers for Medicare & Medicaid Services announced to States that the agency was suspending enrollment in the Preexisting Condition Insurance Program. Very little was said of the fact that this program was intended to help individuals with preexisting conditions through the 1st of January of 2014.

Despite lower than expected enrollment, the Centers for Medicare & Medicaid Services announced that it will no longer enroll new individuals in the program, and it will bar States from accepting new applications because of their financial constraints.

According to a report from The Washington Post:

Tens of thousands of Americans who cannot get health insurance because of preexisting medical problems will be blocked from the program that was actually designed to help them.

On March 5, along with Republican leadership and the leadership from the Energy and Commerce Committee, we wrote to the President. We let him know that this was not right. We let him know that, while we may have designed the preexisting pool differently, Republicans have supported risk pools, and that he could easily use funds from other accounts in the Affordable Care Act like the Prevention and Public Health Fund. But so far, the response to our letter from the President is zero.

I support prevention activities. As a doctor, I know it's better to keep a person well than to treat an illness; and to anyone across the aisle, we've demonstrated this in the past. If we want to modernize government programs where they have fallen behind private insurers and employers in avoiding disease and getting people more involved in their health care, we're here to talk.

But the prevention fund has been used in a haphazard way, with no unified vision and in many ways that are quite questionable, with the mere hope, with the mere aspiration that 10 years from now we can look back and think that we've made a difference. But it's really something I cannot support when we are $17 trillion in debt and sick Americans are being turned away from an insurance coverage that they were promised by the President.

As a physician, ensuring those with preexisting conditions have access to quality and affordable health insurance is a priority. As much as I believe that the Affordable Care Act stretched the bounds of constitutionality--and I still do--I was concerned that if the Supreme Court had invalidated the law last summer, those who were in this new Federal preexisting pool would have had the rug pulled out from under them and they could have been barred from merging into their States' pool because of the previously provided coverage.

That's why, to ensure that that did not happen, I was prepared to answer that challenge, had it arisen, by introducing legislation prior to the Court's decision to provide States with the financial backing to decide how best to provide coverage for this population through some type of risk pool, reinsurance, or other innovative method.

I will also note that unlike many of the complaints that the Preexisting Condition Insurance Program has faced, that bill, as well as the bill that we are considering today, did not require those with preexisting conditions to jump through hoops or to remain uninsured for 6 months before being eligible for coverage. On the other hand, instead of making sick Americans a priority, the administration is telling them to just give us 10 more months. Well, what a striking comparison.

There are always stories of those who have done the right thing and insured themselves and then, for whatever reason--falling on bad luck or hard times--have fallen out of the system, usually because of a job loss, they get a medical diagnosis, and when their employment status changes, they find themselves forever locked out of coverage. Those were the stories that people thought of when they did say they wanted something done about this issue.

I might add that when the Affordable Care Act was passed, the administration and congressional Democrats vastly oversold this concept. We were told time and again there were 8 to 12 to 15 million people wandering the country with some type of preexisting condition that were excluded from coverage. It's interesting that now, here we are 3 years later, spending $5 billion and they've enrolled a hundred thousand people in the program. But it's a hundred thousand people with a very compelling story.

We were told by the American people they wanted us to fix this problem, they didn't want us to screw up the rest of the country's health care, and they wanted some help on cost. But, unfortunately, we failed on every one of those counts.

Since the administration has cut off enrollment, how many people have signed into or aged into the 6-month exclusion that would otherwise be able to sign up? The fact is we don't know. But we had a hearing 4 weeks ago where we heard from some of these people. They do have compelling stories. How many were awaiting coverage but are now told, especially in States where the Federal preexisting program is the only option, you just wait until 2014. So do the best you can with what you've got between now and then.

I will admit that many of the current State-based programs are underfunded and lacking the ability to meet their needs. It is costly to deal with this population of patients. I was prepared in the bill that I offered last summer to authorize $30 billion to provide coverage. House Republicans supported $25 billion in our substitute to the Affordable Care Act back in November of 2009.

H.R. 1549 will redirect $3.5 billion from the Prevention and Public Health Fund and then eliminate the fund in 2016. The Congressional Budget Office estimates that, unlike the authors of the Affordable Care Act, we have provided enough funding to meet the needs of the program through the end of the year, while ultimately reducing the deficit. Furthermore, once the ``train wreck'' of failed implementation occurs, the amendment that Mr. Pitts plans to offer would provide an escape valve for Americans with a preexisting condition by providing States with a block grant to fund State high-risk pools.

The majority is serious about funding these programs and dealing with the issue, and those cost are a drop in the bucket as to what the Affordable Care Act will cost our country in the future. But those efforts recognize that for those who do need insurance and are truly uninsurable in the market, it will be costly but we will make the decisions that set our priorities straight.

Where the President's response was to tell the people tough luck, not to prepare for needing more money or transfer funds out of other parts of the Affordable Care Act or to look for efficiencies or mismanagement in the preexisting condition program or even approach Congress for funding, dead silence from the administration. Well, here Republicans will lead and ensure that we help sick Americans now.

I reserve the balance of my time.


Mr. BURGESS. I yield myself 1 minute.

You know, on the subject of wasting time, it was 6 or 7 weeks ago that Chairman Pitts sent a letter to the President saying: What are you proposing to do about this? This was not something that was in the plan. You promised something that was different. What are we to tell people who are now calling our committee and asking us how you're going to respond to this?

The President chose not to respond to that letter--it's been 6 or 7 weeks--but, boy, it didn't take him 24 hours to turn around a Statement of Administration Policy that said they would veto this bill should it pass the House. That's another reason for me to be for it.

But, look, in this Statement of Administration Policy, it says: The Affordable Care Act forces most insurance companies to play by the rules. Well, I think this House has an opportunity today to say to the administration: Play by the rules.

I reserve the balance of my time.


Mr. BURGESS. Madam Speaker, I yield myself 1 minute.

It takes me back to when the Affordable Care Act passed this House and the tumultuous time in March of 2010. I had 18 amendments in the Rules Committee the night before that. The ranking member may remember that. None of those amendments were made in order. Look, if that's the yardstick by which we're going to measure, we've got a long way to go.

But I need to respond to something that was said by the minority whip. He referenced the Appalachian train wreck. These are not my words. These are words that were used by a senior Democratic committee chairman about this bill. And then just today, breaking news, I'm handed an article from Politico, another senior Democrat, chairman of the Health Committee over on the Senate side, is putting a hold on the administrator for the Centers for Medicare & Medicaid Services nomination.

And why is that hold being placed? An aide said that the Senator objected because CMS was using Prevention and Public Health Funds to pay for the health law implementation; the very reason we're here today.

I reserve the balance of my time.


Mr. BURGESS. Madam Speaker, I yield myself 1 minute.

There's nothing that has been more damaging to job creation in this country than the first 2 years of the first Obama term. During that time, with vast majorities in both the House and the Senate, the anti-employment, the outright hostility to the productive sector of American society, was palpable. People responded to that in very predictable ways, so they hunkered down.

And then you come throw the wet blanket of the Affordable Care Act. What did that do to job creation? It killed it in this country, and it is killing it today.

If you want job creation in this country, you will provide some stability, some sanity, to allow those people who are still in that hunkered-down modality that they've been in since the first Obama administration was sworn in, allow them a chance for real economic recovery. That's why it's important to divert those funds from the Prevention and Public Health Fund, help those people with preexisting conditions, and, yes, we may get some sanity out of the administration on the implementation of the health care law if we do that.

I reserve the balance of my time.


Mr. BURGESS. Madam Speaker, I yield myself 1 minute.

The last Congress we had this debate over and over again, which obviously culminated with the significant findings in our Committee on Energy and Commerce on what happened with the energy company called Solyndra. The moneys that were pushed out the door by the Department of Energy in the first 4 years of the Obama administration, those moneys were poorly spent and unwisely invested. And what did we get for that investment? More debt.

Here we are faced with a condition in the Prevention Fund where these dollars are going to be pushed out the door hiring navigators. Remember, part of the Affordable Care Act was to absolutely remove insurance agents and brokers from the environment, and now we're going to populate the environment with these navigators that are going to help sell people health insurance, and they're going to be paid for out of the Department of Health and Human Services with the prevention fund. It doesn't sound like prevention to me. I think we ought to prevent that from happening.

I reserve the balance of my time.


Mr. BURGESS. I yield myself 1 minute.

Since the gentleman wasn't here in the spring of 2010 when the Affordable Care Act passed, he probably didn't hear the utterance of the then-Speaker of the House, Nancy Pelosi, who famously, from that chair, stood up and said, ``We've got to pass this law to find out what's in it.''

Here we are a little over 3 years later, and we're still finding out what's in it. Yes, the law is the law--the law has passed; the law is signed--but what has happened since that time is this torrent of regulations that has come out of the Department of Health and Human Services, the Department of the Treasury, the Office of Personnel Management--all of those Federal agencies charged with implementing this failed product. Now, we can argue all we want about settled law being settled law, but rulemaking is going on even as we speak. New rules are coming out. New rules are being promulgated.

Look at the Essential Health Benefit Rule. Why did the administration hide the ball on that one until 2 days after election day? Because they were afraid of what the public's response would be when they saw what that rule actually said. It turns out that most of the Nation's Governors said, We don't want any part of this.

I reserve the balance of my time.


Mr. BURGESS. I yield myself 1 minute.

I think it's important for Members of this body to understand one of the things we're talking about today. It's section 4002 of the Patient Protection and Affordable Care Act. In my copy, it's found on page 466. This delineates the outline of the Prevention and Public Health Fund.

Section A: The purpose is to establish a Prevention and Public Health Fund.

That all sounds good. It's to be administered through the Office of the Secretary to provide for the expanded and sustained national investment in the maintaining of public health. All good as it sounds.

Then the funding section. The funding section is important because it's unlike other sections of law. Yes, it started small with literally a half billion dollars in fiscal year 2010. It escalated from there, and by next year, this fund will be up to $2 billion a year. That's self-replenishing in perpetuity. That's until the Earth cools another time or the Second Coming. It's $2 billion a year forever.

Now, the use of the fund is the next section. That is telling because there is broad authority for the Secretary of Health and Human Services to transfer these dollars to other areas she wants. That is what leads to the problem. That is what leads to the difficulty with this section.

I reserve the balance of my time.


Mr. BURGESS. I yield myself the balance of my time.

Madam Speaker, as the gentlelady mentioned, we've heard a lot today.

I think I've said over and over again how I, unequivocally, oppose the Affordable Care Act and would like to see it forever dismantled and thrown on the dustbin of history. Guilty as charged. That is what I would like to see, but that's actually not what we're talking about today.

We're here today to talk about the President's promise to help people with preexisting conditions obtain health insurance, and it has been one of the few areas of agreement between Republicans and Democrats over the last several years. House Republicans have urged the President to work with us on a solution to this issue, but all we've heard from the White House has been silence. So, today, we are offering a solution:

The bill transfers funds from an unnecessary slush fund and, instead, prioritizes the Nation's most sick and vulnerable who have been denied coverage and who have been the victims of the Affordable Care Act's broken promises. This bill does not provide more money to government health care programs, but instead it helps those who are in desperate need have access to privately run health insurance. Instead of continuing to use the Prevention and Public Health Fund to prop up the Affordable Care Act's flailing exchanges, we would use the money allocated for public health to actually help sick Americans.

If we do not act, the administration will continue to spend this money on heaven knows what: neutering programs, pickle ball--whatever the heck that is--and programs that are rife with potential for fraud and abuse to support their own failing implementation plans. Instead of further increasing this Nation's $17 trillion deficit, we can pass this bill that will provide health care to the sick and will reduce the deficit at the same time.

In the end, it's not about the money. It's about America's patients. The President should be embarrassed. His political bait-and-switch is not working. Instead of putting the care of the sick first, you tell them, Sorry, Sister, we're closed. Come back in 10 months.

Ten months, a week, a day may be the amount of time some of these patients have to get treatment or else face the consequences of the progression of their illnesses.

America's doctors and hospitals will be there, and they'll always be there. But why deny them the means to get their services paid for with insurance coverage?

Mr. President, your health bill fails this country, and, most importantly, you have failed the thousands of sick Americans who can't get health coverage because you think implementing the health care law is more important than taking care of the people who you promised to take care of.

So today we can end the use of the slush fund and use it to actually help people. A vote for this bill is a vote to help sick Americans now.

Madam Speaker, I urge my colleagues to support the rule and support the passage of H.R. 1549.

The material previously referred to by Ms. Slaughter is as follows:

An Amendment to H. Res. 175 offered by Ms. Slaughter of New York

At the end of the resolution, add the following new sections:

SEC. 2. Immediately upon adoption of this resolution the Speaker shall, pursuant to clause 2(b) of rule XVIII, declare the House resolved into the Committee of the Whole House on the state of the Union for consideration of the bill (H.R. 535) to amend the Internal Revenue Code of 1986 to permanently extend the Build America Bonds program. 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 Ways and Means. After general debate the bill shall be considered for amendment under the five-minute rule. All points of order against provisions in the bill are waived. At the conclusion of consideration of the bill for amendment the Committee shall rise and report the bill to the House with such amendments as may have been adopted. The previous question shall be considered as ordered on the bill and amendments thereto to final passage without intervening motion except one motion to recommit with or without instructions. If the Committee of the Whole rises and reports that it has come to no resolution on the bill, then on the next legislative day the House shall, immediately after the third daily order of business under clause 1 of rule XIV, resolve into the Committee of the Whole for further consideration of the bill.

SEC. 3. Clause 1(c) of rule XIX shall not apply to the consideration of H.R. 535.

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


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