the warder chair would recognize himself on the pillow in amendment mr palauan your amendment deals with a wide range of health issues ranging from school based immunization programs to emergency and trauma care i know it represents the work of a number of members who have championed these causes and you have decided to take all of those proposals which in my opinion really shouldn't be all that controversial because they involve reasonable public health matters that we hope will prevent called the class act could you tell us what the class is a great name it's a class the activist the chairman no i'm kidding i'm sorry basically what this says is that people who you know now have to get health services chronically ill people people with disabilities who now have to get services through institutionalization you know there would be a hospital nursing home whatever would be able to pay into a system a voluntary you know pay roll deduction and after a certain number of years you know if if their health becomes endangered they get a chronic illness they become disabled they would be able to tap that so they'd be able to get those services that be provided by a hospital or nursing home in a community setting so it's a way of you know having people finance over their life if you will so that you know when they get to help people in the long term it's  people who voluntarily pay into this fund to be able to use that fund right and this is a major issue mr chairman with the disability community that approached me about this many times i think they approach mr ding sometimes they get very aggressive about it needless to say and they and it's also something that mr kennedy has sponsored in the senate and that is in the health bill not to mention the senate god forbid but you know well that it is an issue that senator kennedy has championed and it's very much wanted and needed there are other provisions in the bill they seem unrelated but they all have in common  provisions that you and the staff felt were worked out and not that controversial menu labeling for example is something that's now been agreed to by all the stakeholders  school based immunizations telehealth reauthorization which is playing more and more of a role in giving people the ability to have assistance from health care providers not in front of them but  allow as i understand it those people who volunteer at a community health center to be put under the same provisions as employees at a community health center they would be covered by the federal torts claim law i had to read pretty quickly through this i didn't see anything in there regarding medical doctor supervision any any way shape or form in regard to the mister deal you wish to be recognized yes mr chairman thank you as i look over there's seventy five page amendment i think i have counted as many as thirteen separate pieces of legislation which i think all of them have in one form or another been introduced as separate pieces of legislation now some of these are feel very strongly supported in fact i am a co sponsor of some of the individual pieces of legislation that comprise this amendment so i'm i have reservations about i was glad to hear the chairman say that everybody that fell under the menu labeling it already come to agreement i was under the impression after reading it that the only way you could get out from under it was to have a blues plate blue plate special that didn't last long for than thirty days or sixty days and that was on the way you going to be able to escape the provisions but maybe maybe those who would be affected by it  have looked at it more carefully than i have but i have a procedural question of the chairman mr m and as i understand it this amendment the blown amendment is a second degree amendment and therefore would not be subject to an amendment to it in order to extract portions of it that might otherwise be considered objectionable am i correct that this amendment is not subject to being amended gentleman is correct all right well i appreciate the response and i personally would have preferred and even though it may have taken a little more time for us to be able to deal with these individual pieces of legislation separately so that people could express their opinions on them individually rather than collectively but i appreciate the gentleman putting forward many of these proposals that are encompassed within this amendment and i will back my time l et me see if the gentleman from georgia if you want to divide the question on these different parts of the amendment i think that would be an appropriate request you want to take out something for separate consideration mr chairman i heard expression from some of our members of perhaps an indication that they would prefer to do that i'm afraid time wise we haven't had a chance to get a collective judgment on that at this point as well the amendment as it was proposed i would you mr chairman and in light of your apparent offering on that i would like to request that the menu labeling authorized clearly that was the case in the no child left behind legislation for many years there were arguments made that a large sum was authorized and then it was never fully funded so counsel can you direct me to where the authorization five may be necessary and finally on page seventy five for the extension of the wise woman program for screening preventive health screening for women seventy million dollars seventy three point five seventy seven eighty one and eighty five in six those of the total i'm sorry sir i do not have the card appropriations levels for those programs mr chairman do we have the current appropriation level somewhere three line t n established mechanisms for collecting and distributing payments that is clearly jurisdictionally totally within the ways and means committee so if dr burgess is liability language was not germane because of some jurisdictional totally within committee this section is not germane because it is totally within the jurisdiction of the ways and means committee so you know what's good for the goose is good for the gander well i just want to say very briefly that this was written specifically to avoid the problems that you're raising by saying that the program does not go into effect until and unless the secretary sets up this you know voluntary payroll deduction so it's written to specifically of void the jurisdiction of the ways and means committee and that's my understanding that that it says specifically the program does not go into effect until a statute is passed that does that stablished the voluntarily payroll deduction so we have to actually have legislation to accomplish that that's can can be taken to to recognize symptoms to get to medical care it actually helps to educate some of the providers that have not become aware of the information that's available program for cooking classes as no no is screening actually provide screening for older women who aren't necessarily covered in any other way so that they can become aware of symptoms that they might have it's a way to get women into treatment more quickly than to wait till some costly treatment is perhaps needed later reclaim and i mean although nutrition education might be of order itself chair is willing ready to rule the point of order as been asserted that this amendment is not germane for two reasons primarily that it  passes a provision that would be in the jurisdiction of the ways and means committee on page four the effective date says that the public health service act provision which is in our jurisdiction shall take effect on the effective date of a statute establishing a voluntary payroll deduction under the internal revenue code of one thousand nine hundred six to support a program authorized by such title that it had we legislated a  effective statute in the of the payroll deduction that would be outside the jurisdiction of our committee what we do is in this particular provision is establish the program at about the program which is under the public health service act would not take effect until the ways and means committee stablish is the tax the second assertion of non germane is that the  community health centers provision giving liability protection would not be in our jurisdiction this amendment to allow volunteers at the community  to be covered under the liability protections under this act is under the act in the public health programs the community health centers are under the public health act and the parliamentarian in the past has always referred such bills dealing with anything dealing anything pertaining to the health centers to us including liability protection so that you're would rule that the five minutes or whatever minutes we have because i know most of the speakers on the other side are concerned about laying out a manager's amendment and if the staff could explain being on this committee for a number of years i remember this same thing happening having a bill and then coming to the committee markup on a regular occasion even when the majority was a republican to have a manager's amendment laid out for our consideration is that not correct  published and both sides had a chance to look at it before we went to market for a number of days we never wrong so to speak and manager's amendment and i i don't remember ever having to manage had compromise legislation that included part of depression on the issue of abortion i was just wondering why the compromise language that we passed in the two previous congress congress wasn't included in this language could you i think i think this is very important because increase research on post abortion depression would lead to greater awareness of the issue and the development of compassion  all night long and i want to commend him for that well i commend you but i would suggest that you withdraw this amendment there are some good things in it there's obviously some good things in it but it is a little unusual for the majority for their first amendment to an omnibus amendment that was not readily accessible under normal conditions before the mark so we're basically got fifteen minutes before we in for the day because we're going to the next series of votes of the last votes of the day and they're going to take two or two thirty and by previous agreement we'd agreed to in the market today about two o'clock so we're correct i thought counsel was asked whether managers amendments are common i did not hear counsel asked if managers amendments to manager's amendment are common council that the chair will  if you find any rule that says this can't be done please raise it otherwise we have a request from mr barton to withdraw the amendment john of new jersey has withdrawn it i would take the recommendation of the gentleman from to put the whole thing aside and i understand somebody want to look at that language as well to be sure so the light requirements so the whole matter is put aside including the separate issue in the  capacity of local medical facilities and at the same time it would help returning veterans transition into civilian life authorizes grant funding to create a fast track for military medics to become emergency responders it also commissions the g a o study identifying obstacles keeping former military medical profession professionals from entering civilian  medical field mr chairman everyone here understands the extraordinary service reform via military medics on the battlefields in iraq and afghanistan they are the true  mister however we did work with a veteran committee member on this and we have been exploring how to solve this problem in the most effective way and we have come to a significant set of provisions within the underlying bill that address the workforce shortages and we've we've attempted in that respect to design pipelines deployment we have to see where we can rapidly deploy caregivers even as we are developing these pipelines over time harmon is focused i think rightly on the tremendous potential in terms of the profession to transition these returning veterans to that kind of work and to do it in a timely basis i'm also attracted to another portion of this and then ask the g a o to conduct a study to look at other ways that we can or other opportunities to transition returning veterans into other kinds of roles going forward so this on the one hand is addressing the workforce shortage that we are very concerned about on the other hand it's providing a tremendous opportunity to our returning veterans and it's in keeping with other initiatives that we've undertaken in this congress are there any states who are already reviewing this are there any models out there already in existence that we might know of i understand that kansas and maryland are already doing this very good i thank you so much on your back my time  so there are two reservations a point of order mr sullivan you recognize now for five thank you mr chairman i have an amendment for the amendment to the in the nature of a substitute mr chairman i have a commonsense good government amendment today that is important effort to stop wasteful and inefficient government spending in our health care programs my amendment would require the health and human services secretary to conduct a study on new and old programs affected by this legislation to determine if there is any program programs within six months i'm particularly concerned with the number of new government programs that are created in this bill this legislation is adding at least thirty one new federal programs agencies grant programs commissions and mandates with our nation experienc reduce public spending on health care we need to find taxpayer savings where we can just this week it was reported that our budget deficit has already topped one trillion dollars for the year was on pace to grow to nearly two trillion by the fall i think we can all agree that inefficiency duplications and wasteful spending are having devastating consequences for the fiscal health of our country my men what would help stop any wasteful or duplicative spending in this legislation i believe that we are if we are all going to keep putting new spending and programs on the table then we absolutely must have a mechanism to take old things off my minute provides a mechanism to do just that again on my commonsense amendment does require a simple study on federal programs in this bill and allow the secretary to take action on inefficient programs i think everyone agree can agree to this especially in light of the deficits we are facing in this country and i yield back to him and yells back as i withdraw my reservation  the chair recognizes themselves on the amendment i am certainly sympathetic to what you're suggesting that we make wise investments and not have duplicative efforts but i'm worried about this amendment the underlying bill requires the secretary to develop a national prevention and wellness strategy which i think would address your concern that strategy requires a secretary to inventory current prevention and wellness activities it requires or do a de specific national goals and objectives and set priorities for future initiatives the secretary must also develop a plan for addressing these priorities taking into account unanswered research questions and on that prevention and wellness needs and this report to be submitted to congress no later than one year after enactment of this provision what differs is your amendment which would require a study which we also have its own judgment before programs that we've authorized are terminated by anybody in the executive branch i'm ready to terminate any program that's necessary and redundant and and not cost effective but i want the congress to do it i don't think it's appropriate to delegate that authority to the secretary and for that reason i would have opposed in the midst of our mr chairman i rise in support of the solomon amendment  we thought this was the single most innocuous good government amendment that we could offer in good show we were going to try to work to to improve the bill without destroying any of the underlying principles that the majority is embedded in it this amendment fairly simple says the secretary of health and human services who by the way is wanted by president obama within a year has to look at all the new congress and then if in that study the secretary determines that some of the programs are duplicative and we even change this a little bit we said to the maximum extent appropriate term and other federal programs within this division so we even gave a little leeway there if you look at your underlying bill and you create a brand new commissioner who can terminate people's guarantee cost containment but it at least directs the secretary and gives the sector the authority if you have duplicative programs under this division to try to save some money i think it's an innocuous amendment and  check it it's fact i don't think we ought to give the secretary this kind of power any secretary and you pointed out the secretary at the present time has been appointed by president obama if you were willing to say that would not difference of opinion about separation of powers under the constitution the congress legislates the executive branch and ministers what you're saying is you don't trust president obama's own appointees to administer the  programs that you put into place you legislate you want to micromanage i mean secretaries have they have the authority right now to terminate programs and  presidents have the authority even when congress appropriates not to spend those funds if they don't agree with the intent of the congress we're just trying to prevent duplicative programs you know this is a  the issue that i think mr burton just raised which is what authority there is to do away with plans and whether the commissioner has the authority to do so i believe it page sixteen line beginning with line twenty grace period for current employment based health plans the bill of language says that a plan can exist current plan of the health care plan for employers right health care may continue exist for five years without meeting the requirements then minimum requirements prescribed by the health care benefits advisory committee for that five year period at the end of that five year period if it does not meet those requirements it goes away so as i understand it the commissioner does have the authority to wipe out all existing plans at that point in time and i believe that's what mr barton was referring to it's not something we need to go into now we can go into at a later point indeed i have to ask for clarification from counsel a later point in time with that i'll be happy to mr rogers of michigan thank you and i and i think others who point to the i think the problem of dropping a twelve hundred page bill where i think nobody's read the bill clearly and maybe mr chairman you haven't got to page forty four section of that page of enrollment of individuals under such plan after the date of commissioner notifies the entity of determination so not only can you do a whole plan which is in a later section in the bill under this page they can actually go to an individual and throw you off a point so it is clearly under the bill of which you have written that they can throw people off the plan and you've given not only the secretary but this new health choices  what i think is so dangerous and if you're concerned that they can do that mr chairman sounded like you were maybe we ought to postpone this hearing and actually allow us to go through this bill and find those instances where you have empowered the federal government that's roll individuals off their bill and by the be happy of the gentleman from oregon i just want to follow up and maybe enter into a colloquy with my colleague from michigan because are you saying that this unelected commissioner can do something to throw people out of their insurance plans without notification perhaps is that what you are saying under the bill that is written and has been presented to us yesterday that is exactly what they can do the suspension of enrollment of individuals under any plan after the commissioner notifie but we're hearing that that shouldn't be allowed too much of a delegation of authority but yet in the building kick people off a plan without i mean not only taking them off the plan sir but on the second paragraph down they can also suspend payment to the entity under health insurance without notification gentleman yield to me to the chairman i think that being raises a red herring and let me tell you why we allow the commission to look at the insurance plans to be sure that they meet the requirements under the law that this bill would promote for example of an insurance plan where discriminating against people based on preexisting condition and they refused to make a change in that plan that plan would be qualified to be operated that is the power that's given not to say that individuals that they can no longer get insurance no one would be for that but we're not talking about that section of the bill reclaiming my talking about a different section chairman has pretty much on limited time reclaiming what limited time i have left and having on the past been criticized consuming all the time i've given let me just say that i appreciate the gentleman's explanation but that does not appear to be the words of the bill the words of the bill seem to indicate that plans must go out of existence as a ruling of the commission or certain point in time and that seems to be in the commissioner's discretion and the language raised by mr rogers makes it they've also done this with the later on in the bill and i don't have the section before me that says the secretary can do it for an entire plan and in a company with consultation with the health choices commission they can actually eliminate section of the bill that is being used for a different interpretation than what i think the clear reading of it entails it the remedy described in the paragraph with respect to a qualified health benefit offered by a qualified health benefit plan is they could have civil money penalty or they can suspend the enrollment of individuals under such a plan after the date the commissioner notifies the entity of a determination under paragraph one that they plan does not qualify that is a way to enforce the requirement that the plan be qualified but let me just say even if you read it differently the issue before us and i don't review your interpretation because i wouldn't want to give secretary anyone in government such enormous power but the amendment that's pending before us by mr sullivan gives the secretary the power to terminate authorize programs that may already be appropriate where there may be even appropriations of funds i think congress would want to have a strong recommendation to terminate those programs we don't disagree about that but we disagree about in this instance in the soul of a man is whether the secretary should have that power in her opinion wouldn't that apply to all programs with the public health service act that address prevention it requires the secretary of the new programs and the existing programs and then authorize the between what counsel just read and other provisions of the bill where the secretary supposed to report back to us about these various programs i think there's ample opportunity in the legislation now to have either her or the congress subsequently terminate duplicative program so i just don't see the need for the sullivan amendment i just think it's unnecessary giving what the underlying bill s no no angle angle no mr murphy of connecticut murphy no if the german with we are trying to clear a number of amendments together i know i was going to do it in block between baldwin number one gordon zero zero two and green zero zero gee mr chairman i reserve point if the gentleman from texas would modify his unanimous consent to do the green and the baldwin amendment we have no objection the republican side has no objection to that