Providing for Consideration of H.R. 160, Protect Medical Innovation Act of 2015, and Providing for Consideration of H.R. 1190, Protecting Seniors' Access to Medicare Act of 2015
Floor Speech
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Mr. BURGESS. Mr. Speaker, House Resolution 319 provides for a rule to consider two separate bills, which will address two of the most flawed and ill-conceived provisions contained within the so-called Affordable Care Act.
The rule provides for 1 hour of debate on H.R. 160 dealing with the repeal of the medical device tax, equally divided between the majority and minority on the Committee on Ways and Means, as well as the standard motion to recommit provided for the minority.
The rule further provides for 1 hour of debate on H.R. 1190, which would repeal the Independent Payment Advisory Board. This is equally divided between the majority and minority of both the Committee on Ways and Means and the Committee on Energy and Commerce. Further, the rule provides that the Pitts amendment, which will cover the cost of repealing the Independent Payment Advisory Board by using the Affordable Care Act's prevention fund, a slush fund for the Secretary, which has been used to pay for everything from urban gardening to lobbying for higher cigarette taxes, be added to the bill. As with H.R. 160, the standard motion to recommit is also provided to the minority on H.R. 1190.
It is well documented that many provisions contained within the Affordable Care Act will have negative consequences on patients, both in access to care and in affordability. Yet two provisions have been so universally criticized that, on a large bipartisan nature, their repeal was called for almost immediately after the passage of the Affordable Care Act in 2010. One such provision was the tax contained within the bill on medical device manufacturers.
It seems illogical that within a piece of legislation that was purported to make medical care more accessible to all Americans, the Federal Government would want to tax the very providers of medical innovation that creates the devices to improve the delivery of health care. Nevertheless, the President and then-Majority Leader Harry Reid in the Senate included this provision in order to pay for part of the astronomical price tag that accompanied this massive bill.
This tax is an unfair burden that actually increases the cost that consumers will pay at the doctor's office. 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 the Internal Revenue Service stifling their growth. This tax slows the creation of new techniques, slows the creation of new devices, all of which could make the delivery of medicine more efficient. It also puts at risk the jobs associated with the creation of those devices.
And lest anyone think that we are merely talking about the largest and most expensive pieces of technology found within a hospital, such as the MRI or the CAT scanner and 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 the syringes that are used to deliver lifesaving antibiotics and vaccines. In my own district, I have met with a number of constituents, including the owner of Retractable Technologies, which makes those very syringes, and have been shown firsthand how this tax is creating a burden on the growth of his company.
The medical device tax has led to the elimination of thousands of good-paying jobs, and repealing it would be the first step in bringing those jobs back to stem the loss of future jobs within an industry that is vital to the country in helping to mitigate the rising cost of health care due to other burdensome provisions within the Affordable Care Act.
Mr. Speaker, plain and simple, this is a tax on business, a tax on small business, a tax on consumers, 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 well over 100,000 additional jobs are on the chopping block.
Actually, who could be surprised about this? Excise taxes, which this tax is, are meant to lead to a reduction in the consumption of the good being taxed. We place an excise tax on cigarettes to discourage their use, making it burdensome to afford a smoking habit. Did the President and Harry Reid intend to make it more burdensome to use more efficient medical devices?
Of course, not only is this burdensome tax ill-conceived as a concept, it was ill-conceived in a practical sense as well. Last year, a Treasury inspector general audit found that the Internal Revenue Service issued 217 erroneous penalties to device companies in a 6-month period. We have all seen how poorly much of the Affordable Care Act was written. One need only to look at the most recent Supreme Court cases for that determination. But how difficult is it to write a clear-cut tax provision? Apparently, for Harry Reid, it is quite difficult.
H.R. 160 has bipartisan and bicameral support and currently has 282 cosponsors. In fact, 18 Democrats in this body sent a letter to Speaker John Boehner and Minority Leader Nancy Pelosi calling for the timely passage of this bill. Republican leadership in the House heard their requests and the calls from many other Members of this body and is moving this bill in a responsible way to put Americans back to work and lower the cost of health care for all.
The second bill contained in today's rule,
H.R. 1190, repeals one of the most poorly thought-out ideas ever to come out of Congress, and that is really quite impressive considering the many disquieting ideas that have originated in the Pelosi-led House of Representatives. The Independent Payment Advisory Board is an unelected, unaccountable board dedicated to set up within the Affordable Care Act for the sole purpose to cut Medicare payments to providers if Medicare targets within the bill are not met.
Let's be very clear about this. President Obama, Majority Leader Harry Reid, Speaker Nancy Pelosi created a board of unelected officials in order to ration Medicare, to cut Medicare, and every Democrat who supported the Affordable Care Act voted in favor of this Board.
The Independent Payment Advisory Board is a regulatory board composed of 15 health professionals appointed by the President. There is no requirement that any of these professionals have ever actually practiced medicine a day in their lives, and we are well aware that this President prefers academics to those who have real-world experience.
The Board's stated responsibility is to develop proposals to reduce the growth of Medicare spending. What does that mean? It means seniors will face cuts to their health care with no recourse if they don't agree with what the Board proposes.
Former Office of Management and Budget Director Peter Orszag, the President's top budget adviser, called the Independent Payment Advisory Board the single biggest yielding of power to an independent entity since the creation of the Federal Reserve. Think about that. Let that sink in. The Independent Payment Advisory Board has been given the authority to do for Medicare policy what the Fed is able to do with monetary policy. That should be terrifying to every American.
The Independent Payment Advisory Board is set to recommend cuts, amounting to one-half of 1 percent of Medicare spending, and then the number rises until it hits 1 1/2 percent. It makes these cuts by reducing the rates that Medicare pays for medical procedures and drugs, which means the Independent Payment Advisory Board can only make cuts to providers' reimbursements. Instead of being allowed to make real lasting structural reforms that could actually help the solvency of Medicare, this Board's approach to saving money is one of the clumsiest, most bureaucratic ways of achieving this goal.
The Independent Payment Advisory Board has massive structural and constitutional defects in its design. If Congress fails to act on the Board's recommendations, they automatically go into effect. And even if the Congress did pass a bill countering the Board's cuts to Medicare, the President can simply veto the bill. And the judiciary--and how this passes constitutional muster, I seriously question--specifically the judiciary, is forbidden to review the Independent Payment Advisory Board's recommendations.
For these and many other reasons, over 500 organizations have urged Congress to get rid of this thing--repeal the Independent Payment Advisory Board--including the American Medical Association, the American College of Surgeons, and the Veterans Health Council.
Repealing the Independent Payment Advisory Board would protect seniors' access to Medicare, encourage us to do real Medicare reforms, and put an end to the constitutionally questionable Board of unelected bureaucrats--right now under the President's healthcare law--the very decisions that they are empowered to make changes to Medicare.
All Americans will benefit from the repeal of this draconian idea. It is a clumsy way that then-majority Democrats were able to buck their responsibility at addressing cost concerns over entitlements. Government by bureaucrats instead of government by the people, government by bureaucrats instead of government by representatives, it is no way to run this country. And yet that is how then-Majority Leader Harry Reid and then-Speaker Nancy Pelosi preferred that we operate.
The Independent Payment Advisory Board's design undermines seniors' access to Medicare and the health care that they need and have paid for throughout their working lives.
This Board should have been repealed years ago, but so long as Harry Reid was majority leader in the Senate, the Independent Payment Advisory Board continued to live. Last year's election created a sea change over in the other body, changed the majority leader in the Senate, and now, the American people may finally see their government begin to work for them yet once again.
Mr. Speaker, I reserve the balance of my time.
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Mr. Speaker, we have talked a lot about the Affordable Care Act here on the floor of this House, and one of the reasons we have talked a lot about it is because, very famously, it was passed before we read it. We had to pass it to find out what was in it. Let me just talk about a couple of those things because I think they are germane to our discussion today.
This is June 17. Around the country, many Members' offices are being contacted by groups asking why Congress
itself isn't following the law that Congress passed. I am referring specifically to section 1312(d) in the bill. It says:
Members of Congress in the exchange requirement notwithstanding any other provision in law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress shall be health plans that are, number one, created under this act, or two, offered through an exchange established unto this act. The term ``Member of Congress'' means any Member of the House of Representatives or the Senate.
The fact of the matter is most people don't follow the law. I did, Mr. Speaker, and I think it was important to follow the law. I bought my health care in the individual market, in healthcare.gov, started October 1 of 2013. You may remember that night. That was the night the fiscal year ended and the famous government shutdown began. I began early that morning in trying to sign up for the Affordable Care Act because I knew, as a Member of Congress, we were supposed to sign up through healthcare.gov, an unsubsidized policy in the individual market. So I performed as indicated.
It took 3 1/2 months for the check to clear the bank. It was one of the most uncomfortable, god-awful experiences I have ever been through in my life. What is the final result? I have a bronze plan in the individual market in healthcare.gov, the Federal fallback provision in the State of Texas.
Mr. Speaker, that plan cost $560 a month the first year that I was enrolled, and then it went up 24 percent the next year. It is now up to $700 a month for me for an individual. These are after-tax dollars. Do you know the worst part, Mr. Speaker? The worst part is that the deductible is $6,000.
Now, some people have asked me, they say: Well, gee, are you worried about the fact that the networks are so narrow on these plans that you can't see your doctor?
I honestly don't know. I don't know if my doctor is included on the plan. I haven't looked because I ain't going. At a $6,000 deductible, someone will have to drag me in the backdoor by the time I am dying.
What has happened, Mr. Speaker, is we have created a whole subset of individuals in this country who are functionally uninsured because the cost of their care is so high. Had Members of Congress followed the law, they would be as aware of that as our constituents are.
Mr. Speaker, today's rule provides for the consideration of two bills that begin to right some of the many wrongs included in the Affordable Care Act: H.R. 160, repealing the Independent Payment Advisory Board charged with cutting Medicare; and H.R. 1190, repealing the medical device tax. These are two steps that the House can take this week to help lower the rising costs of health care created under the President's healthcare law.
Mr. Speaker, I urge the adoption of the rule before us and the passage of the two important pieces of legislation.
The material previously referred to by Mr. Polis is as follows:
An Amendment to H. Res. 319 Offered by Mr. Polis of Colorado
At the end of the resolution, add the following new sections:
Sec. 3. 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. 1031) to reauthorize the Export-Import Bank of the United States, and for other purposes. 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 Financial Services. 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. 4. Clause 1(c) of rule XIX shall not apply to the consideration of H.R. 1031.
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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.
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