if the clerk has the amendment the desk i'd like to have the amendment report well and then the offer by mr barton page ten after line four insert the following new sub paragraph as chairman i ask unanimous consent in be considered as read without objection that that will be the order can question whether we should have a federal policy mandating broadband deployment i one would for one would answer that we should not do that having said that it's obvious in this bill that we want to instigate such a policy i'm somewhat puzzled by how it's been implemented note on page five of the broadband section line eleven adopt rules to protect against and i quote on just enrichment which leads one to believe that there is such a thing as just enrichment it goes on to say that any by the receives a grant meet certain buildout requirements so we're doing a mandatory build out and then we talk about open access so we're overturning the private sector's ability to manage their own broadband networks requiring undefined open access policy what my amendment does is say if you're going to have one of these grant programs we shouldn't let people that are already being heavily subsidized by the federal government receive an additional federal handout so what this says is that any entity that's already receiving funds  under the high cost universal service fund program this costing the taxpayers four billion dollars a year right now are under the rule electrification act which is a loan program which in the current fiscal year expected to cost three hundred million if an entity is already receiving funds on the either one of those two programs they are not eligible for funds under this grant program if this amendment were to be accepted in adopted what  wouldn't that the other eligible entities such as state local local governments state governments municipal entities like that are a are a broadband provider who is not a part of the universal service fund are the rule explications loan program there would be more money for those into d s since they are not receiving subsidies so this is kind of an answer double dipping amendment that says if you are receiving funds under one of these these two programs then you can get guns under this broadband deployment program so  i would support the amendment in hopes that it could be adopted by voice yeah we have some question about whether that possibility or not you chair recognizes himself i have a lot of sympathy for what you're trying to accomplish but you would prohibit any receipt of universal service funding or us funding from applying for the n t i a broadband grant if we adopt this amendment we might inadvertently harm eligible entities that would otherwise be were the recipients of an n t i grant the universal service fund is not a broadband fund thing it's meant to support telephone service many suggest that the fund should be reformed to support broadband but that's not the case now since this is primarily a broad band funding bill i don't think we should restricted to only those parties that do not receive us of dollars there may be we see appearance of us half dollars that wish to deploy broadband services apart from the have supported telephone service and we don't want to discourage that secondly under the terms of the program n t i a is already required to consider whether unjust enrichment will occur as a result of an eligible entity receiving support through another federal program for service in the same area in other words n t i a is directed to watch for double dipping by eligible entities third this could negatively impact the provision of service in some of the most rural areas in the us for example we might see a wireless carrier applying for a grant to provide wireless voice service and then unserved area or wireless broadband in an under served area but if that wireless provider also has every sip the end of us half dollars it could not apply for a grant in effect this would mean no service would be deployed or service would be  delayed we should be encouraging wireless companies and others to offer brad broadband service in the most remote areas and finally under the our us program we've discussed no area of a project funded with amounts made available may receive funding to provide broadband services under the broadband deployment grant program in other words our us will not allow an eligible and indeed a double dip for the same area i commend you for raising the issue of double dipping and i look forward to working with you mr barton and others on our committee to make sure all funds related to this program are managed appropriately i just don't think we need to adopt this amendment here especially if it has  consequences and yield back the balance of my time members seeking recognition on the barton amendment if not will proceed to a vote all those in favor of the apartment barton amendment will say i or the geographic area the purpose of this amendment is to eliminate this arbitrary prohibition on states submitting grant program requests to serve areas that may include more than twenty percent of their geographic area when you are representative for a big western state there are enormous geographic areas that may be completely served or very under served and i for the life of me don't understand where this twenty percent figure came from or its relevance to the cause to build out broadband areas that are not served so i offer this amendment as a striking amendment very simple just to take out this pro arbitrary prohibition twenty percent on geographic area because if we're really sincere about getting broadband out into unserved and rural areas and i don't see why we'd put an arbitrary geographic limitation in this legislation the gentleman yield certainly we see nothing of actionable in this amendment we think it makes sense and we would support it i think the chairman any further discussion of those in favor the members say i oppose no the ayes have it the amendments agree to other further amendments or ca under served defined later there are things that have to be done as a result of mapping we want to make sure that we understand i also understand the percentages although they're arbitrary represent the idea we just don't want states coming up with plans for the us they want to really trying to target this but i'm concerned that i represent a city that is hyper well wired and is the communications capital of the world but we have pockets within our city that are places like the navy yard that are being developed and others that are that are literally some of the don't even have coaxial cable or or traditional allies the end lines coming in and i just wanted to engage the chairman in a colloquy just to make it clear that the f c c is free to look at pockets within well sort of communities to make sure amendment requires a report back to this committee one year from the date of enactment from the federal communications commission the required report will contain a national broadband plan for the country the recovery package contains funding and direction on gathering broadband deployment data and creating an interactive broadband map of the nation that broadband deployment grants will spark new broadband builds in an served and under served area s these grants will fund wireless and wireline deployments these grants will be designed to push industry to deploy higher speeds to consumers and businesses and advance the cause of hastening the day when americans get the type of broadband speeds and affordability that our international competitors such as career in japan france and the u k and others deploying and enjoying today these provisions are a digital down payment on our economic future yet for far too long the united states has not had a concrete action plan for broadband policy for too long our broadband policy has lurched forward and backward in a random haphazard way with little consistency or urgency during this time the united states has fallen behind other nations and almost every metric used to gauge broadband status around the world speed affordability deployment to rural areas subscribership in certain urban areas pricing and other metro with the funding for broadband mapping the collection of broadband data by the f c c and the grant program contained in the bill we have a new opportunity for the f c c to pull together a comprehensive blueprint for our nation's broadband policy going forward for consumers and civic communications this is an important exercise for small businesses  towns and villages across the country that may help excel or rate their access to worldwide markets through the internet this recovery package also contains billions of dollars for health information technology the digitizing a patient records and bringing hospitals and insurers and bamma sees into the modern twenty first century this amendment requires the f c c to develop a plan in fact all of this together what is happening across our country from the new telecommunications driven grids to telecommuting to health i t so we can get a blueprint for what is happening and then we can  ensure that a plan is implemented that ensures that those problems are solved so i hope that my amendment is adopted and i yield back the balance of my time gentleman yield back the balance of this time as a further discussion mr blair at the end of section thirty one zero to add the following new subsection without objection the memo will be considered it is read in the gentle lady from colorado is reserved a point of order gentlemen mr boyd reckoned he was chairman  this is the the amendment which i sought to offer that was ruled out of order as a as a third degree amendment i brought it back because i want to build off of the work of mr stupak and build off of his logic and i concur with his logic with regard to when the map with a broadband in the tory map is released the definitions would then be revised it only makes sense then that the allocations are then thereby marquis's amendment because mr marquis's amendment that was just now adopted is income grew it with what is existing in the allocation saying that seventy five percent is going to go to under served and only twenty five percent to those who are not served at all now he just he just asked us and the committee adopted his national broadband plan that under paragraph b says the contents of the plan shall seek to ensure that all people of the united states have access to broadband capability and shall establish been smart for meeting that goal yet in the base bill there are allocations that are in congress to this so what i hope we're doing here is i to i want to make a correction of this in congress i want to couple exactly what mr markey has done with his national broadband plan and i also want to build off of the good work of mr stupak and i would ask the committee to adopt this when you're served and served under served mikkel pretty well put that with the farm bill which we just tighten up the requirements of the real utility service program i think i think all of america will  serve without knowing more information i'm not inclined to start changing formulas on it this was put together again by the house the senate and current administration and i just don't think we should be going down this road i appreciate with these trying to because good suggestions made by members of congress on both sides they just simply ignored so i'd rather go with the base bill as written as the bring in here again and they'll say oh everything's wonderful disaster thirty days later with their number just asked for from the f c c to ensure that all people the united states have access to broadband capability so if the map comes back and we say you know what we really messed up this allocation will not be able to achieve a national goal would you be willing to work with the committee here to change the elec and if that's the situation be willing to work with you and i know mr markey would hold hearings to make sure he got it right and soul so i'm confident let's leave it like it is if we have that problem let's  cross that bridge when we come to it mr markey wants thank you gentlemen we don't think this solved we just honestly believe this is a downpayment on solving the problem so we'll be revisiting this issue in the in the years ahead there's no question about that so i think that misses two pac as expressed correctly the reasons why there is a balance in this bill the way it is right now and we can come back as a committee and revisit it in another  year to make our own determinations but we should be the ones making the determination and that area so i thank the gentleman field well thank you and i know i said mr markey would hold hearings i guess to be mr boucher but no one mr markey he would claim it's global warming and he'd grab your stiction and try to have a hearing on it anyways amendment i look at this bill and i look at how we are delegating the f c c the authority to write these definitions that i believe we don't have the ability to write because we don't have the information to write alter your definition definitions of under served to comply with whatever n t i tells you meanwhile we've allocated as a aspirational goal seventy five percent of the money to the under served and twenty five to the unserved of three billion dollars we're doing all this in two hours time here and then i'm hearing well in the years ahead we'll take a look at all this and see how we did and i i was told maybe somebody can help me with this that right now the federal government spending about thirteen million dollars on broadband buildout is that that accurate anybody know how much we're spending this fiscal year maybe i direct a council you don't keep track of that buy on the committee know how much we're spending in this country right now on broadband buildout well ok i don't have i'm at all by an appropriator it was thirteen million million with an m and we're going to spend three billion in this committee and three billion more two point eight five billion more  the ag committee on broadband buildout with definitions we refused to write that we delegate to an agency to do and then to revise after the states have submitted their applications if we think the coupon program is a mass  wait until this gets done served and non served is done well enough we won't need another variable so i had the gentleman to consider waiting until the maps have been drawn and if the drug properly the under served and  unserved will be allocated properly without having to go through another variable change from my experience trying to manage to variables at once on something is as undefined in a squishy is this is going to make the problem more difficult  more intractable yes that's what this amendment is trying to accomplish what what what this has to pack is done is is he's basically said let's don't let the f c c make these definitions let's go to the map and the map will help us define what the under served and unserved areas are i'm just saying once that map defines them shouldn't that then be the basis of the allocation not just us here being capricious allocation already given then they'll know how to decide the unserved in the in the under served without having to add another variable to the whole process and that just makes in my opinion adds to the are we ready for the question all those in favor the boy or amendment say i oppose no no the nos have it the amendments not agreed to do you really of all members responded to the roll so the in support of the russian minute but it would ask a question if universities that were disadvantaged out of the bowl championship series would be considered to be economically disadvantage socially disadvantaged under the definitions of this act the ayes have it the members agree to we now come to voting on the broadband underlying print as amended we have to vote on the on the new a committee print as amended all those in favor say aye aye aye opposed no no the ayes have it and the motions agree to ask unanimous consent that staff be authorized to make technical and conforming corrections the committee will now consider the print on energy initiatives without objection the committee print will be considered as read the clerk will designate section one of that committee print parliamentary inquiry mr chairman gentleman status parliamentary inquiry we were told earlier before the mark that there would be a manager's amendment for each that would hydel that would be presented by the chairman at the beginning of each title your i'm in your motion that you just made did not do that do you intend to do that after she reads yes after she completes reading section one then it will be open to the amendment process and i will offer an amendment the nature of a subsequent other parliamentary inquiry we have reported by voice for the broadband title at the end of the market will there be a vote on all titles as amended are are we doing that sequentially so that there'll be no other votes for example to report the broadband title is it now released from the committee's jurisdiction or do you have at the end some mechanism that we report the final package as a unit we're anticipating after we've completed all the committee prints to do a unanimous consent to put all of the titles together in one bill at the end of the market at the end of the markup on all the committee prints so we w be going back into this we have finished the broadband title  still do the same for title to entitle three and then will report it as one vote is that it is going to be viewed as a final passage then of the committee's work at that  point we will take title by title and have a vote at the end of each title after all the amendments of been considered within the time allotted to that at the end of the completion of all the titles we will ask unanimous consent that all the titles be put together in one bill we will not ask for a vote on that bill the reason  we will we will do that so that we can get minority views offer to the completed package so in other words we'll go through this process to title two to do title three and  that point were really our work voting is done well i think we have two other four and five but whether we've completed all the titles and all the amendments that will be offered to all the titles we will be finished with our work and we will ask unanimous consent so that we can have the opportunity for a report right ok we offered we'll offer we will put all of the titles together so that really a minority and majority report can be objection my guess is that we would have done each of the titles and that will be it so why would there need to be a unanimous and we're doing this at the request of the minority so that the minority ba submit a minority views on the total package seven the the committee will be considered as read no point to a member of any point and i have an amendment at the desk clerk will report the amendment nature of a substitute and then the nature of  without objection that amendment will be considered as read and without objection amendments drafted to the committee print regarding energy issues are made in order to this amendment in the nature of a substitute i recognize myself to speak on the to speak on the amendment the nature of a substitute the american recovery and reinvestment act will accelerate deployment of smart grid technology offer support for the nation's governors and mayors to tackle their energy challenges and establish a new loan guarantee program to keep renewable energy on track during the economic crisis it accomplishes these goals primarily by relying on the committee's work in the past much of the energy related funding in the bill is directed at programs that our committee wrote that are now a lot but given the amount of investment necessary at this dire time legislative action by the committee is necessary to ensure that existing programs can be scaled up to invest promptly and effectively substitute i'm offering effectuate a number of technical corrections and other amendments to achieve these goals let me summarize a substitute for you briefly section five zero zero one makes it technical correction to the energy efficiency and conservation block grant program which was acted in the energy independence of security act of two thousand and seven without this correction certain provisions in the statute are overlapping and confusing section five zero zero two immense title thirty of the sun to allow small smart grid demonstration projects to florence to assure the results of the demonstration projects will be public knowledge and to increase the percentage of smart grid matching grants to fifty percent from twenty percent the substitute includes re several refinements to this provision at the she gestured of subcommittee chairman markey and mr weener including require requiring grantees to utilize open internet based protocols and standards when available and ensuring that projects are supported in geographically diverse cities suburbs and rural areas section five zero zero three as a temporary loan guarantee authority to title seventeen of the energy policy act of two thousand five to provide loan guarantees for commercial renewable energy systems and electric power and submission systems that begin construction by september thirtieth two thousand and eleven substitute clarifies the categories of eligible recipients of loan guarantees it also states the transmission projects including upgrading and reconned doctoring are eligible for guarantees and provides factors for the secretary to evaluate in offering guarantees and clarifies that renewable energy systems that generate electricity are also eligible and i'd like to thank representative bono mack for her work to ensure that transmission upgrading is eligible under this provision section five zero zero five a man's aware there is a should an assistance program authorisation to increase the threshold for household eligibility for assistance from  hundred fifty percent to two hundred percent of the father federal poverty income levels and to increase the per home maximum assistance from twenty five hundred to five thousand at the suggestion of representative space the substitute also allows a secretary to encourage states to pursue separate elements of weatherizing eligible homes such as attic insulation sixty five thousand and seven requires the secretary of energy to include an analysis of the transmission issues facing renewable energy in the study of electric transmission congestion due to be issued in not august of two thousand and nine this direct secretary to make its assumptions and projections publicly available in that report the substitute also contains two additional provisions that are not currently in the appropriations committees economic recovery package section six thousand one is a provision that conditions the award of state energy program funding from the recovery bill upon a notification to the secretary of energy by the governor of a state that the governor will seek to ensure to the extent of his authority that the state adopt one certain utility regulatory policies to encourage you to lety sponsored gains in energy efficiency into updated energy efficient building codes this provision has been endor by a coalition of industry trade associations and environmental groups the alliance to save energy the american gas association edison electric institute and the natural read sources defense council have all endorsed this provision and finally six thousand to section six thousand to waive certain caps on grants and loans under the energy sustainability efficiency grant and loans for institutions program for the economic recovery period however the provision requires more than eighty percent of a project's cost be provided as a grant these changes are targeted to ensure the rip recovery act would work in a timely way and i want to thank representative ross and hate to keep asking parliamentary inquiries but we've been told that you are going to ask unanimous consent that you remember the nature substitute be considered as original text you haven't done that yet are you going to do that without objection the amendment in the nature of the substitute will be considered as what is best text for the purposes of and thank you mr chairman amendments to this title  amendments clerk will report and have distributed the amendments memon i am one that supports renewable energy for sure whether it be wind solar tide it cetera but we also know that when we look at the addition of renewable energy anywhere in our country it has to have access to transmission lines we have to build those lines to get them into the grid so what this amendment does it simply asked in essence for reporters no any additional cost simply asked for an analysis of the extent to which legal challenges filed at the state and federal level are delaying the construction of transmission necessary to access renewable energy so mcgill i will be willing to accept the cement mine i'll withdraw my reservation my my time without objection the reservation of a point of order has been withdrawn the gentleman from michigan us back the balance of this time we are ready to proceed to a vote on the upton amendment number one all those in favor gentleman from michigan is recognized to explain mr chairman what this bill does what this amendment does is it adds really three words to the zero it adds the word zero emissions energy  after the words renewable so that in fact as we look to reduce our carbon footprint and emissions we do it with more than just renewable we also say zero  job stimulus bill and we know that there are literally tens of thousands if not more than one hundred thousand jobs that would be added if we could increase our nuclear portfolio nuclear energy across the country so whether it be  hydrogen fuel cell vehicles whether it be nuclear whether the hydro a whole number of different things we just we just say that our goal is the same that is renewable we are also be looking at zero emissions and include that as include new incentives for nuclear reactors in the economic recovery package this is a bill for two years and according to the nuclear regulatory commission no permits for new nuclear reactors will be issue in the next two years so it's not a question of the merits of the amendment but it doesn't fit in this in this legislation no amount of new federal incentives will change the fact that there are no projects ready so there's no reason to include nuclear incentives in a package intended to stimulate the economy in the next two years it could also if the general will yield at a later time time carbon capture  with clean coal and would be could be considered on this and i know that is you indicated the other day we are hoping to have a bill done in this committee by the end of may a lot of those targets that were suggested in the us cap in fact  and eleven so i would think that clean coal technology which we know that can reduce emissions could could well be part of this and again it would add jobs gentleman yield there in another provision in the bill there's two point four billion dollars for chairman a question because if they if the bill is what he says is correct it's only a two year bill but that there's for some reason there is a potential for a plant that there's no there's no intent to exclude a potential nucular operation but in addition the nuclear power two thousand and ten program pays up to half the nuclear industries costs of seeking regulatory approval for new reactor sites applying for new reactor licenses and preparing  plant designs so there are other guarantees available to nuclear power but this loan guarantee program will sunset in two years and nuclear power cannot meet this deadline it is already eligible for billions of dollars in incentives and subsidies so i think we ought to preserve the stimulus intent of this program and not have this amendment because the chairman i agree i just didn't want  point that when we started our nuclear power a number of decades ago and we built plants around the country eighty five percent of those components in those facilities were made in america since then we really turned the light from green to re on new nuclear construction and because of that when and if a new nuclear plant becomes online and i was in mr dingell's district earlier this last year and looked at a planted a new application had been filed and i believe that there is eight or ten in fact that are close to be coming filed with the n r c today when we build those new plants that they are allowed to proceed which i hope they are eighty five percent of those components are going to come from someplace else  not the u s and that's one of the reasons why the pipe fitters steel workers a whole number of different union organizations support nuclear power because they know that those when we turn that green light on back on nuclear power those jobs are going to be here and if we can tell them in fact that we're close to turn in that switch back to green those steel companies in pennsylvania and indiana i mean the nuclear engineers of graduate particularly from our big ten universities but other places around the country they're going to know that there's going to be a job for them and these are good paying jobs so the quicker we send the signal and that's why i think you know that is we look at france which is pretty close to ninety percent of their electricity comes from nuclear power we know that this is an emission free no carbon released this is something that we ought to proceed on that the more signals we send that it's going to happen by including this year old mission knowing that it's more than just nuclear because it is clean coal it is hydrogen fuel cells a whole number of different things it sends the signal to the right folks that yes we're ready to bring those back people back into the workforce and i'd like to think that we could include this at all my man has expired and i'm going to ask for construction companies as we speak or it's expanding their existing manufacturing facilities and and you nearing send theirs in north carolina indiana pennsylvania virginia tennessee and louisiana and we're talking about high quality skilled craft and engineering jobs estimated to be somewhere between fourteen to fifteen thousand new jobs being created by the end of this year and into next year the us cap made it very clear in their report and this is going to be our blueprint for our climate change legislation that none of what we're talking about works without a balanced approach and nuclear certainly part of that balance that we talk about now we all support this grant program for renewable energy i don't know anybody that opposes it and i support it one hundred one hundred percent but we are talking about a zero emissions zero greenhouse gases being admitted right in the state of pennsylvania westinghouse  is making the a p one thousand for every country in the world except the united states of america and they just hired three thousand employees and the last year or two at westinghouse and pittsburgh to build these a p one thousand is creating good jobs for family sustaining jobs for americans right here in our country it's part of the mix it's not the answer it's it's part of the package and anything we can do to  facilitate the creation of power that doesn't emit greenhouse gases deserves our consideration i just want to voice my support for the sentiments being expressed by mr upton whether or not the answer is to fund them in this stimulus package may that some of the unions that originally supported this amendment told us they were withdrawing their support once they realize that nuclear has a lot of other loan guarantees and money to assist them the question was asked what harm does it do if you add this in it we don't really know it might it might confuse things if i might just ask the gentleman from michigan to withdraw them and let's look at it a little bit more carefully and see if needed if it does if it's not needed what are we why put it in there if it does if it does no harm why object if it doesn't harm then that should be a concern for all of us i know you have a deadline today reporting that's when would all this happen well i would get it into the bill and you know it could be on the floor as early as tuesday you i think we should why don't we accepted and see what happen here anymore so if we look to even keep nuclear energy at twenty percent which is what the level is today when we build it we have to build fifty four new plants by the year two thousand and thirty to maintain twenty twenty percent we have to go overseas for all these parts we have to go to japan we have to go to korea to have these things built that are such a long queue when i was in china last year or the year before i was told that they were going to build one hundred jobs here in america to have those skilled tradespeople men and women and to send that signal i would like to think that we could vote on this week and i know we have a lot of amendments and we'll have a very quick vote hopefully it prevails and is part of the package and we can move forward dollars in loan guarantees to cover eighty percent of nuclear power plant construction cost of the vision of two billion the loan guarantees for uranium enrichment facilities and the loan guarantees for two years  o the nuclear industry is eligible for one point eight cents per kilowatt hour as production tax credit generated from the first eight years electricity generated from the first eight years of a nuclear power plant operation  those plants come on if those plants come on line before twenty twenty one under existing law that we passed in two thousand and seven and two thousand and five the nuclear power two thousand and ten program already law pays up to half of the nuclear industry's cost of seeking regulatory approval for a new reactor sites applying for new reactor licenses and preparing detailed plans designed video he has requested two hundred forty one million nuclear power to  fiscal year two thousand and nine which is an increase of one hundred seven million they also receive up to five hundred million dollars in regulatory risk insurance and protection on the price anderson act this section here is meant to deal with power transmission  projects and renewable electricity which was kind of left behind in the past so that we could ensure that we have investment that's commensurate with that problem as well which is why i recommend the same outcome that the chairman did for this section we're ready for nuclear powered uses zero emissions and it is obvious on the face of it that a nuclear power plant doesn't have any emissions so it would be eligible so this is simply an eligibility addition so it doesn't have a cost to it  it's just per missive it's not mandatory and i listened very closely to the chairman's objections and i must admit less closely to mr marquis's objections because i don't know what his based on prior hearings and our new chairman says the money won't be spent in two years well if that's the standard there's not a lot of this so called stimulus package in this committee jurisdiction we need to be moving today because most of the money that's been authorized is not going to be spent in the next two years so that's not a standard we can use unless we use it to the whole package in which case especially we get to the health section we're go there wouldn't be a lot of the health section from what i'm told left and so what mr doyle says we need to listen to we have an industry whose the technology is there the reason they're not going to be a nuclear power plant power plant construction started is not because the workers aren't ready in the technologies because the nuclear regulatory commission is taking so long to approve the protocol and if this committee will exert its jurisdiction we could cut that gordian knot and after actually have some applications approved within the next twelve to thirteen months and construction permits i simply want to join you and rise in support of the gentleman's m and it seems to me that the discussion here is focused on nucular but that is not the language of the m m and quite frankly the base bill does not define renewable energy and it leaves me open to ask a question i've asked in this committee many times before which has to do with the issue of hydro power hydro power is a renewable source of energy and yet this committee at times has defined it as not to renewable source of energy there are more and more high tech applications of hydro power where in stream flows can be tapped i haven't my own amendment to add hydro power specifically and to deal with a number of other forms of energy which i think are renewable which were set forth in the energy policy act of two thousand and five but which  not to be included in this definition it seems to me that zero emissions makes all the sense in the world it would help clarify the absence of a definition that i can find in this act and i certainly rise in support of the gentleman's memon gentleman yield to me would we've already authorized loan guarantees and money for nuclear power and so they can come in and get access to that this section of the bill is money that is designated for renewable sources of energy in the amendment which say renewable and zero emission i just think it confuses things it doesn't appear to work in the context of the two years before this i have she's well i just wanted to thank you for you i just wanted to restate something that maybe many of us have forgotten about now that it's a new year and that is that ten billion dollars w billion dollars in loan guarantees were put out to the nuclear industry last year so is this is that not enough i mean have all of these loan guarantees been taken up on i shadegg i simply would ask the chairman since uses the word mobile power does that in fact include the subject stream if you ask my thinking about it the water keeps coming it's renewable year i think it is renewable and years ago on this committee i had to bring forth a copy of the hydrological cycle which i took out of a third grade informs me that they don't think it applies to the hydro i just i read that third grade book and so that's where i got my opinion but i don't have to rely on the experts  from the energy policy act now i want to ask the chairman chairman chairman this term that someone now has placed in the in the base tax on line sixteen renewable energy systems am i to assume that those three words were taken from out of the energy policy act well they're looking it up mr chairman what i have in front of me is that the term renewable energy system means a system which when installed in connection with a dwelling transmits or uses solar energy energy derived from geothermal deposits energy derived from biomass or any other form of renewable energy which the secretary specifies by regulation for the purpose of heating or cooling such dwelling or providing hot water or electricity for the use within such dwelling now what we have in front of us the reason i've asked mr chairman this question is that the purpose of your loan guarantees is for commercial technology projects so we have to go back to work congressman again we have if in fact we're going to be referring back to a definition out of the zero five policy act it's in reference to residential dwellings for people of purpose of of heating and heating water if what we're trying to do is saying to the manufacturing sector of the country mr chairman maybe it's a large manufacturer the has its own cold manufactured facility that maybe they're willing to take that down and replace it with a win or a solar farm i think that's something that we would want them to do but counsel have any views on the subject views in terms of preferences but clarifications as to the law there is a section of definitions in title seventeen which provides for the loan guarantee program that section does not include a definition for renewable energy systems if it is defined it is defined elsewhere in the pact and perhaps is divine separately for the title in which it's defined and may be defined more than one way but we're not sure that well then we have a challenge here is that we do you can have a challenge before us even if in fact our challenge is that these three words are defined in the existing law and by regulation by the secretary we're about to use those three words again and yet we're not defining them however we want them to be used in commercial applications and so now we have ourselves at a bit of a challenge we can't this isn't something we can defer to the counsel we have these three words that are being used in this legislation and we have existing regulation based off of the zero five policy act how do you what is your sense how this will be interpreted then by the department of energy with the german will to me i'm being informed that the department of energy has sent out a solicitation for those who wish to take advantage of the funding and they have set out the qualifications as they see it now i don't know if we have that i don't think it includes nuclear i'm not i'm not advocating i'm just trying to figure out what the definition means i will include hydro geothermal solar wind you know creates the authority of the secretary of energy to define it for purposes of that title there could be more than one way of defining it for different provisions of law there indeed may be more than one application of renewable energy systems in different titles department of energy will issue regulations for loan guarantees and in those regulations may well define the term with specificity but we are not aware of any single definition of renewable energy systems that could be expected continue on this discussion because perhaps we should as the committee of jurisdiction that authorizes define what we mean by renewable energy systems and generate electricity so that the agency knows rather than wait for the agency of unelected people to dictate to us what they think this definition is and what they think we met me i come from a region that relies heavily on hydroelectric power for its energy generation that hydroelectric power  it has a zero carbon footprint it repeats itself as nature cycle repeats and yet even there we've had a debate over which hydro is renewable and which isn't depending upon the age of the facility through which the water flows which seems kind of well ridiculous so i just i would again i would go back to council and say what would your if if the if the department of energy came to you and said what are the committee mean by renewable energy systems to generate electricity to what will you point in our transcripts to tell them what we me there may be legislative history from the adoption of title seventeen and he packed zero five that could shed light on that but on an ex post facto basis i don't think i would be able to guide them because if i understood you right you've told us that there may be various definitions of renewable energy in various places in the statute and so is it correct to presume then that the agency will have to figure this out on their own and then we'll decide later in an oversight hearing whether they got it right in effect i mean are we delegating not a fair question to you are we delegating to them the authority to write a new definition or write a definition of what  energy systems that generate electricity that qualify for this loan guarantee program will be to the extent that there is not specific legislative history that would elucidate that and to the extent congress has not provided a specific definition then yes you're delegating the authority to the secretary of energy in the administration of this program to define it and so am i correct in that that is exactly what we're doing here today if we don't provide a furthe definition and renewable energy systems a general electric city i'm not aware of whether or not there is this effect legislative history in the title seventeen and that that process so the agency will just be able to pick and choose what qualifies here that's you don't have to answer that i'll just make that statement once again though in the rush to get this out in a partisan way i think we are not fulfilling our responsibility to the people whom we're borrowing this money from to spend it correctly and so mr chairman i would hope before this passes out of here that we'll have a fairly simple definition added in that tells us what's included and what's not and then we can vote on it we who are actually representatives can vote on what we think should be in here provide the stimulus for jobs and to get those systems going reclaiming my time and then there are modern hydro facilities for example there are new generating generators that as i understand the practice of the department in soliciting applicants has not included hydro there are small scale nuclear electrical generating facilities company in my state that wants to  sell commercially available small scale nuclear would that qualify as renew i think the answer would be no there are small scale solar and small scale wind would they qualify i think that there would be yes there are bio mass facilities that use  electricity as a byproduct would that qualify commercially available today let's let your time is up mr markey is seeking recognition and perhaps he can answer those questions in his time because he understands it's a question that's pending i appreciate mega star there and i  in order to put on a fast track and as part of a stimulus plan over the next two years the kinds of projects that can create jobs can be completed in a relatively brief period of time  realistically you can't say that about a nuclear power plant the takes eight to ten years even these new technologies that the gentleman is talking about in this small a farm are still untested and it will take some time before any one of those facilities is completed at least six to eight years the same thing is true with hydro power hydropower because of the siting issues because of the environmental issues because of the long process that has unfold before there is a sighting of a hydro project also falls outside of the two year time frame for this stimulus package there are issues that we can debate in other contexts in the course of the next two years and energy legislation but for the purposes of this legislation just understand that the the the context is in ensuring that there is a shovel ready component to it the regulatory process for hydro understandably because most of the easy hydro was built beginning in the eighteenth thirty's up in my congressional  nuclear that's not a renewable to the center which it requires the mining of uranium which is not a renewable resource in order to provide that energy source so this section is focused on renewables it's focused the electric transmission and i understand what the gentleman is but just by definition the the goal here of the stimulus package as opposed to everything else we're going to do after we finish it  have these projects begin and be completed over the next couple of years with gentlemen you know that so i want to make two points one is in to make just as well a correction if i could on small scale hydro development i have projects that have gone in in my district in the last year as new inserts in piped irrigation systems that are now generate electricity those some of those can go on i mean there's a lot of they were controversial they decided to pipe their canals and decided to put small scale hydro inside the pipe so now they generate renewable energy they pressurize their systems they're not having to pump as much and the water is surplus water is now going into the rivers covered by this language and what's not so is incremental small scale hydro would they be available to take advantage of loan guarantee program or not and if the gentlemen would just give us a little bit of time to work on that issue that is this incremental issue then we may be able to come back to you with an affirmative answer but aren't we on a time limit time and i'm so i'm talking about and over the next hour or so then let me add if i might add one other and facilities would woody biomass even if that would comes off federal land qualify for loan guarantees so that they can move forward on very low emission boilers that produce a byproduct of  eligible for this program as well so it would be under this definition i would say yes well gentlemen because i know that when i when solar sightings that's going on in my district those are multi year efforts to that i would i would say yes and it would also be the intent that  inquiry of the chairman mr blunt instrument on this and on the on the previous section we've had so many questions that we decided we need to get answers for but we have such a short time is there some deadline here about when this bill has to come to the floor i mean why why can't we have more time to have answers to these questions so we could decide whether this committee needs to have an impact on the legislation or not as opposed to just somebody in some point  future working out what happens here is there a timeline here that we've been asked to work with that i'm not aware of and could you are leading the senators than that tomorrow they're going to go to the rules committee next week they're going to take up the bill they're trying to accommodate the schedule set out by the president the united states who has argued that we need a stimulus package as quickly as possible to move the economy forward and in that regard he's been backed by many this i sympathize with the gentleman concerned i've been on the other side of the of the fence on this in this committee in the minority and it would be desirable to have a lot of hearings and talk things through and be more deliberative it i was critical at times when the republicans rammed through bills without the full deliberation but at the request at their insistence of their leadership we were faced with not just a leadership demand we're faced with an imperative by the american people that we do something about the economy right away and this provision that we're discussing is to provide loan guarantees to encourage commercially available renewable fuels and to give them loans to get going not because it happened to be in anyone's any member's district but because they will have the greatest impact on the overall economy moment mr chairman we all know how difficult those republican leaders were and they would charge we've emerged on that but we've never had a piece of legislation anywhere near this big or this financially impactful and the idea that the deadline is tomorrow is is an amazing thing and i thank  the chairman for answering the question thank you we ready for the vote on the pending upton amendment all those in favor of the optimism and say i oppose no no what show of hands all members respond to the roll if so click will tally and report the vote on that mr chairman the eyes are twenty one and the nays are thirty three eyes twenty one days thirty three the amendment is not agreed to further time today i'm pleased to offer an amendment with mr brayley that will provide five hundred million dollars in loan guarantees to leading edge biofuel products prot projects as you know companies around the country are now developing advanced bio fuel technologies to convert homegrown cellulosic biomass into liquid transportation fuels such as renewable gasoline diesel and jet fuel the benefits of these cost effective carbon neutral fuels include providing more net energy to our communities creating jobs lessening energy dependence and helping farmers maximize land utilization and the value of their crops however the current economic situation has made it access to capital difficult and it's inhibiting the ability of these companies to be truly successful expanding the loan guarantee program already in place in the stimulus bill to  will help to ensure adequate capital and allow us to further develop viable biofuels produced from a wide variety of plentiful and available feed stocks mr chairman these funds are designed to be temporary with authority to enter into new loan agreements expiring as we've just been discussing on september thirtieth two thousand and eleven i would urge my colleagues to support the baldwin brayley amendment with a gentle a deal to me yes i'd like to com d you and represented brayley for working with us on this amendment this amendment is a well crafted amendment that will help usher in the next generation of biofuels that could help us achieve our climate and energy goals our new secretary decision as to how to determine that particular number is just in the real world it just doesn't work we're not sure what a leading edge biofuel project is you'd be much better off just to offer this is a five hundred million dollars program for biofuels generically and then let the appropriate authorities at the department of energy and environmental protection agency if necessary issue the regulations to implement that program i know we're trying to move a bill very quickly because of the constraints of the new president but we've shown repeatedly today in this brief markup you know the the value of actually using the regular order each of these titles could have had a at least a one day hearing in which we had experts  answer the kind of questions that our new chairman and our ranking member and our subcommittee chairman have been speculating on we've got new counsel they're doing the very best they can absolutely no problem with their honesty and integrity but they're new on the job you know there's a reason you have a hearing and then you have a subcommittee markup and then you go to full committee and it's showing up today we're rushing through a multi hundred billion dollar bill simply so we can have a bill on the floor next tuesday the obama transition team the obama administration doesn't know the impact of what's in this bill so again that's not to demean the gentle lady wisconsin's amendment that simply points out that hermann has undefined terminology in it and she has a concept a lifecycle greenhouse gas emissions standard which doesn't exist chairman and we're going to have a five hundred million dollar pilot project based on on that type of a situation so i would again i'm not i'm not castigating the intent of the amendment i'm not opposed to the amount of greenhouse gases and one of the problems they're having is lifecycle including land use which we will see how the impact of this amendment i was going to ask the sponsor the amendment that seems to be the problem that e p a is having on adding land use and there is life cycle would it be your intent to to include that although you know again maybe it's the old e p a or the new and i would like to see what the agency will define a has been working intensely to develop a methodology to calculate lifecycle greenhouse gas emissions and they're on the verge of proposing a rule on this topic not only is it possible to calculate the lifecycle greenhouse gas emissions e p a s doing it now us the specific question of whether something would be included in it or not i don't know that i can answer that question and i would be concerned by doing this we would be prejudging whatever e p a does or not reinstate any further discussion mr brayley thank you mr chairman i want to thank you for working with representative baldwin and me to improve the rapid deployment loan guarantee program in the stimulus bill i remembered in this program will ensure that leading edge technologies are eligible under the loan guarantee program to become eligible of biofuel projects must prove its potential to become a commercial technology and show that it's cleaner than gasoline or other current transportation fuels there's exciting new technology and i want other states that will improve the efficiency of ethanol and biodiesel plants and other biofuels products that are essential to be part of our new energy package and our amendment will ensure that biofuel producers and i want other states an modernized to meet changing demand whether the recession and retaining create good paying jobs in addition many traditional financing opportunities have been cut off in recent months due to serious declines on wall street like many industries the biofuel industry often depends on loans to make expensive improvements in its technology and our amendment will open this new line of funding for biofuel industry to invest update and expand our amendment offers a true economic stimulus for i when many other states by retaining and creating green jobs through the continued modernization of our nation's biofuel facilities and i want to thank congressman bob baldwin and the chairman and i would also like to respond to the ranking member by citing an indisputable source from the university of nebraska lincoln mr terry which just came out today and talks about the improved efficiencies in the lifecycle energy efficiency and g h d emissions of ethanol predicting a forty eight to fifty nine percent reduction compared to two gasoline based on potential move to new production techniques that will have a hypothetical performance similar to say a loss at biofuels so i think that there are a lot of new there is a lot of new research available talking about the types of improvements that will come in the industry through the incentives that are that are going to be provided in this amendment and i would encourage the members to support it  to point out to my friends from texas who are interested in this there are new technology for algae based gasoline there's a company called sapphire energy in san diego i visited them recently incredible company have developed a robust algae that can take salt water put it in ponds with sunshine do not need a roof and produce gasoline that is eighty s him chemically indistinguishable from the gasoline we put in our tank today the reason i mention that is that the gulf coast of texas is an ideal place for creating a whole new industrial base for the production of gasoline using salt water from the gulf and sunshine that falls on that great state of texas and i hope all of us start to think of our sort of geographic industries taking into consideration the districts we're going to have this in which virtually any place for their salt water and sunshine in this country so i hope that our friends from texas and the gulf states other places where the sun and the salt water can work together to make gasoline will get behind this effort to do this research because it is becoming on the cusp of commercial viability thank you mr chairman whoever has time i'd like to ask or i'd like to have lost track of who has the time concerned again i don't want to prejudge what the me to be doing it if we could look at the admin and just add including land use changes or some law that might make it more comfortable with with what we're trying to do or what  whether we grow it on the gulf coast of texas or or wherever i think that ought to be considered as part of the definition regulations rules that were being developed by all agencies is that true and if so would that include the one we're talking about today from the i have no i have no information to on which to answer that question well i read that in the press so i believe it to be true ok i'm a journalism degree and so i say that because i wonder i did not read how long that freeze on rules development and regulation involvement will be in place and i think that's a valid question that would have come out in a hearing if we'd had somebody from e p a perhaps here and i don't know if the council's track this wouldn't be we could have had a reporter come in for the hearing and tell us where you got that information well it was rahm emanuel put out of the white house put out a ruling saints like like i think every admit incoming administration does to freeze all pending rules in place and so i don't know for how long that is and that would apply if you're trying to move rapidly here the second issue i would ask the gentleman from  wisconsin and that is does your language allow for biofuels projects that are cellulosic and would be from what he biomass and would that include regardless of where the woody part comes from will the gentleman yield yes please yes it is intended to so it includes that off of private lands state lands federal lands wherever the wood comes from but it says that the secretary determines so there's there's flexibility and the reason i ask that is that in prior energy legislation there was a provision put in that said that would be bio mass didn't count for various renewal energy benefits if that would came from federal land now i represent a district that has ten national forests is more than seventy thousand square miles we have a  ton is to say it lightly we have millions of tons of wood he biomass we need to remove to get the forests in shape and yet if we remove them and put them into the biofuels development which there are people interested investing in doing they for some perverse reason under the energy act do not qualify that that does not count against the amount of renewable fuels that we're supposed to meet as a mandate in this country and so that's why i'm i want to seriously clarify here there's nothing in here that i read that would preclude fuels develop from what a bio mass regardless of the origin of that would from being those companies be able to use these loan guarantees is that accurate with the gentleman yes yes absolutely  the language is not intended to exclude any particular product regardless of the land on which it is grown as long as it meets the other qualifications in the language  bill but there is secretarial discretion as i noted earlier but it would be your then if i may ask further is that your intent and the co author from iowa perhaps since it's your remember that you would not be intending or for this committee do intend to and substitute on page six after line nineteen this is within the section seventeen zero five temporary program for rapid deployment of renewable energy it is part it would be five hundred million out of the eight billion that's allocated i mean i'm just how is it going to be applied though do is it venture capital on the part of the government so that these small companies that are engaged as the loan guarantees referenced and in line sixteen the renewable energy systems that generate electricity and starting in line eighteen the electrical power transmission systems including upgrading and want to i mean right do you want to say something no it's just part of the renewable loan guarantee program it just adds another element because the topics that included in our amendment were not included in those two definitions and so it just simply creates another designated shadegg number forty two the proposed section one seven zero five b one insert including hydropower after renewable energy the chairman that's the wrong version the amendment i believe there was now have an america report and read the amendment in section five zero zero three in the proposed section one seven zero five b one insert including incremental hydro power after renewable energy system i think the committee is fully aware that the term renewable energy systems as used in the committee print is not defined and is there is some ambiguity as to whether or not  hydro power is included as the chairman itself indicated earlier there is logic to suggest that hydro power is both a renewable source of energy and also emissions free and yet as the chairman also indicated there was some concern on the behalf of the staff that perhaps hydro power was not included this is a simple and straightforward amendment to specifically include her power on the merits of the amendment i would note that we are talking about a section of the law the talk about the rapid deployment of renewable energy i think the chairman has already quite articulate explained that hydro power is in fact at least biologic renewable and it is emissions free the issue was raised however by the gentleman from massachusetts about its rapid deployment but i would point out that in its new form low head hydro which can be inserted in canals or can be heard inserted in pipelines us mr weldon pointed out in his testimony where the construction a dam is not necessary it in fact can be very very rapidly deployed to generate electricity with virtually no environmental impact whatsoever in addition in prior years i have worked on legislation to encourage the replacement of older inefficient turbans in facilities which already have old turbans but could generate more electricity with newer turbines and so all we be doing is gaining efficiency without any additional damage in terms of environment you could be pulling out an older inefficient turban putting in a new or more efficient term and so there are at least two major categories of hydro power which can be done very rapidly and with virtually no environmental impact and so it seemed to me that it would be beneficial to add those obviously both can create jobs both the installation of hydro power in and in stream situation like a pipeline like  walton was discussing or a canal like we have in arizona or the removal of an existing turban from an existing dam and replace it with a more efficient dam both of those will create jobs and that is after all what i understand the major purpose of this then to the committee print offered by mr lindsey of washington in section six or zero one day and at the end the following new paragraph three the state will to the extent practica prioritize the grants toward funding without objection the measure and considered as read and gentleman from washington state recognized thank you mr welch and i have i think a relatively benign amendment which simply tries to give priority to the energy state energy office's provisions in this bill to give prioritization to existing programs the desire here is to pump this money out as fast as possible and have it in application as fast as possible we simply are trying to do our part to fit within those those goal of of moving quickly so for existing programs our member does not change priorities ition between renewable energy or energy efficiency or does not change existing law in this program between renewables or any other form of energy it simply gives priority to existing programs i don't think we need to engage in any debate about the merits of nuclear power or biofuels or any other issue because we simply are given a priority and program to existing programs so it's a small but i think a helpful effort to try to prime the pump as quickly as possible you know with that idea that mr welch if you have comments i want to i want to thank the gentleman from washington and you stated very quickly i'll just add that there's two issues here one is in the stimulus we want to get money out into work as quickly as possible obviously using existing programs where the infrastructure for delivery is preexisting is going to work best secondly i think many of us on this committee want to take advantage of this hearing and the stimulus to make it clear that this is the beginning of trying to have an energy policy that's going to create help create jobs long term and mr chairman you're insisting on jurisdictional review by this committee is very helpful in that respect but this amendment works off of what we have it takes advantage of the local efforts by states it states a indication that it would be helpful to have this money go to existing state programs that work with public utilities and in some cases the private sector to intensify the benefits of what already is in place so i think it is a helpful amendment and hope that we'll find support on the committee for its passage from are deregulated markets we understand that there are public utility commission really did have the authority j we're looking at the deregulated market states that and how they would give the states the authority states for the state energy offices which are under the governors of the fifty states so we don't intend to distinguish between types of regulatory structure of the states however the states energy offices are currently composed they should we intend to give them equal inadequate access to this program so i don't think it will advantage or disadvantage any state whether they're regulated or under regulated simply pertains to however they handle their state energy offices i just may add to that you know these things have been chronically operating on little crumbs and you look at the potential inefficiency once you for instance help businesses really realize the efficiency potential we have a new course deal for instance and seattle which is  just one of the most energy intensive energy efficient steel mills in the world and they have simply used some fairly common sense things to make investments and stay there g offices that help their industries find easy fish and seas i think and just really find some gold in the hills of efficiency and so i think they're great programs they've been operating on starvation diet so we hope texas can participate in that too for me but i don't know what nucor does in washington but i know what they do  to participate they're all great states thank you green tech specially texas well have no pandering here any further discussion of this amendment all those be the order gentlemen mr chairman this is probably at least in my opinion the most important consumer protection amendment in this in this mark under the bill as it's currently constructed for the first time we would give a federal authority if the governor of the state approved to what is called decouple the prices our consumers both retail residential and commercial paper their electricity you would actually put into place at least potentially a revenue guarantee for electricity generators now because of that edison electric institute who i have a very positive relationship with does support the base tags they want a revenue guarantee and i guess i can say i don't blame them but we represent we the members of this committee in the house of represent we represent the consumers the payers of these rights and the last thing in the world i would think we want to do is do all these great energy efficiency ideas and actually get people consuming less electricity and then not have their costs go down because if the governor of the state approves it requires that the regulatory body if it's regulated in a state that has a p opposed to them doing all these things that they've done so well for so long but i don't think we want to put in place in federal law all a revenue guarantee for the utility companies of america i think we should be protecting the consumers the people that pay the electricity cost and if we just adopt the barton amendment then we we leave the status quo if you have a state that has a regular regulated market and for some reason utilities in that state need more revenue they go to the pay you see and make their case and they get a higher rate if the p c agrees if you're in a state like texas where we have a deregulated market the utility sector in our state can try to get more market share they can try to become more cost efficient they can build new power plants that are more energy efficient they have all kinds of things they can do to try to maintain their revenue in the marketplace but in a deregulated state like taxes they're not guaranteed a specific price this bill gives the authority for the first time for a utility to  e what it's charging from what people are consuming and it's this this is kind of a simple example but if my home is in a regulated state and i'm paying two hundred dollars a month for electricity and i cut my electricity consumption in half if the basics becomes law and the governor of that state approves then i still pay two hundred dollars even though i'm using half as much electricity and i think that's wrong and i i want to put into the record mr chairman the letters that you and i have received from the american force paper association year on light bulbs and part of that was consumers are going to save energy and save money by changing to from the old inefficient incandescent bulbs and now there's no incentive to do that because they're go they're going to use less electricity yet they're going to pay the same right do you want meters that are smart meters so that people are encouraged to use electricity after midnight or so like you can on your appliances washing dishes  there's no incentive to do that so if you're for conservation and you're for consumers trying to save energy the last thing we should do is empower the governor to be able to charge the same amount despite that customer using many many kilowatts maybe thousands of kilowatts less because they've moved on to more energy efficient appliances in light bulbs and i would like to think that the status quo out of stay there we should allow other states to embark on a  scheme that will in fact raise utility prices for anyone who takes advantage of more energy efficient devices whether they be lighting appliances who knows what it might be and i yield back my time as  probably what i believe in the long run will be the single most effective thing for creating jobs in every energy efficiency and giving consumers an opportunity to actually have a less cost over the long run in their utility bill for for reasons decoupling which this amendment would simply got in the bill has been the single best policy in america proven without question to reduce the amount of wastage of energy by americans and i'll tell you what i say that california twenty years ago the average california use the same amount of electricity is as free utilities to sell insulation services energy audit services energy efficient light bulbs fred that's such a great job with what jane harman last year once we give them that ability to make money selling energy efficiency you know what they do they sell energy efficiency services as a result of that single change the average american today uses forty percent forty percent more electricity per capita than they did twenty years ago guess what the people in california do they use no more electricity than they did twenty years ago and you know what they're still got hot tubs they're still living that lifestyle in california and they still got an economy this is a spectacularly successful program that we need to implement second even though it is possible and i say possible even if it is possible that a rate go up for a unit of energy it doesn't mean you monthly bill goes up because if you use less electricity and still have a hot tub even if the rate goes up you don't have more in your monthly bill you just waste less than or genius save the economy second point third creates jobs we're creating a whole new green color industry of people to go out doing energy audit putting insulation change windows change doors put in energy efficient lighting heating and air conditioning systems we're creating thousands of jobs because of the adoption of this policy through earth and this is important i think this goes back to a brock obama's sort of central theme of his inauguration if we're going to create a new economy in this country around clean energy and if we're going to tame this beast of global warming we can't have any red state america and we can't have any blue state america and we can't have an energy efficient american we can't have any energy in a fish in america we've got to have one america that adopts the tools that have been proven to be effective in the creation of these new green collar jobs and for us to use does who we should not put down the single most effective tool that americans have proved this successful so we can move forward together in america i think it's entirely consistent with this fundamental message of the inaugural address so  and by the way i should note i have an amendment that would have even a stronger provision that would say we ought to condition the receipt of this two hundred billion dollars we're given states on actually moving forward on decoupling and building codes so ideal mr markey i think you know very much the gentleman has put his finger on the essence of this provision and why it's so important my mother always said to me always try to work smarter not harder and that was before she would say that she was going to donate my brain to harvard medical school as a completely unused human organ now here what we've seen is decades and decades where everyone believed that the increase in the gross domestic product was tied to an increase per economic unit in the amount of energy we consume what we've learned over time is that if you create the incentives to consume less energy then there is better investment by consumers business and individual in the appliances in the devices which people use and the more efficient they are is the less electricity but under this system the utility still makes money they actually start to get rewarded for concern for actually selling less electricity that's why pollard that's why other utilities are moving to this model because this is the way that the future helps the utility to make money even if this selling less electricity because they're puttering with the consumer so this provision as the gentleman pointed out is central to the long term increase in the efficiency of the devices that the jobs which are created and less consumption of electricity in our society and i urge and i vote for the gentleman  comment the best way for people to move the energy efficiency is for them the reap the benefits of lower cost i'm not a big government guy i don't want the state to do that for me i don't want the national government to me i want to get the benefits if electricity prices went sky high there was a public revolt that almost took down hopefully they should have taken down our government but our government sustained itself and but i will tell you if the people in my electricity market find out that they are using less but paying the same or paying more they this w be held accountable great thing about what happened in illinois was that the public utility commission which represents the rate payers in the state of illinois could intervene and protect the consumer from ranking member i want to ask mr inslee or mr markey if they're the great proponents of this part of the text how you get more efficiency and less consumption if the people that make the investment to do it slide that a slide earlier if steph can they put that slide up again for a moment cause there's a really good answer that's a really good question and there's a slight i want to show you from a company called mckinsey company that's evaluated all of the options we have available to us and while we're fine in the slides just give me a layman ok the layman's layman's answer to that is that when we pay for something we pay for war not necessarily wots we don't care about watts we care about words we care about cooling in the summer and in the winter if they also i can tell if i can tell my constituents that you can have the same warmth in this in the winter and the same cooling in the summer for the same amount frankly they don't care how many watts they just want to know am i warm and am i not paying more money for it now with this reclaiming my time if i tell my consumers and my constituents that they can cut their energy use and they still pay out the goods is there going to and if you make that investment yourself so your energy consumption go down in terms of kilowatt hours per month and yet your your cost goes stays the same because utility just says ok you have the right to have a guaranteed revenue and i just want to make one reference to this chart this is a chart and i really encourage people if you're interested in the subject to read the chart by mckinsey company this is you know really well respected fortune five hundred consulting group if you look at the left of the chart these are all of the things that save money efficiency advancements according to this study by fortune five hundred analysts doesn't cost money it saves money because you make a capital investment and then you reduce your costs over time and we can take school i can barely understand it but i can understand it but i'm talking the real world here if you use a lesson electricity in your home you should save money and if you decouple you don't gentleman no gentleman yield to me i wouldn't chairman seems to me the investments going to have to be made by the energy company not by the consumer so if the energy company now has an incentive to make that investment that they're not going to lose money by not selling more energy th consumers are happy because they're they they get the benefit of the electricity but the investments are going to be made mr chairman i have no more time but i would just end up by saying it's the first time i've heard the democrats of california's energy success and i just want to say that mr upton and i conspired on a brilliant light bulb efficiency bill it will be implemented better in california because of decoupling and the statistics that i have here yes i do trust energy companies with respect to this issue show that that if you do inflation and inflation adjusted basis there was a one point five percent drop in residential customer energy bills per year and an overall drop of about seventeen percent over the time that california's had decoupling so i just want to say i strongly agree with mr inslee i think mr chairman i would ask that we allow one more speaker on each side on this amendment because i know we agreed to finish up this time about four forty five approximately and i know we still have several amendments but go fast although it says three twenty three so don't look at the clock i just this is a huge issue if i go out as an individual customer and by the fluorescent bulbs which i've been doing they cost a heck of a lot more but that's advertised put these in and you're going to save over ten years of their life this amount energy in the average home you buy new energy efficient appliances the whirlpool appliances mr upton suggests then you have you get to save that energy and all this gets calculated in as an incentive to the consumers to drive the market under as i understand the legislation before us you are punished as a consumer because you're going to pay the same amount now i made that may make some people feel warm all over i think mike consumers are going to be hot all over when they find out that they've been had for the energy savings they've put in the investments they've made to cut back their energy consumption and we're going to allow the utilities to guarantee their rate of return by raising the rate i understand rate it's sort of like property taxes yet they've got a lower cost and then they raise the rate and i pay more or pay the same that if you want to incent the marketplace to change then you don't punish the customer and we're going to punish the customer under this base legislation every one  against mr barton's bill is voting to say your customer's going to pay the same regardless how much energy they reduce can you just because i only had one minute left and so i i just think this is the most and i consumer vote you vote against barton that you could make and i cannot believe that any of us goes out there and encourages our consumers to save energy by telling them we're going to reward them with the same cost this is and this is this is the reverse of an incentive system this is a punishment system and and i just think that mr barton is absolutely right this needs to be decoupled and that it is just outrageous that we're going to go down this path i mean one of the great incentives of this country is you get to save because you did the right thing for the environment by using less energy and now we're going to take that away not me i'm supporting mr burton gentleman's yield i thank you i'm going to read to the committee members a letter to us from the alliance to save energy the edison electric institute the american gas association and the natural resources and our d c we write to express our strong support for step six zero one this provision will spur significant investments in energy efficiency which will create jobs save consumers money and create business and create new businesses while reducing greenhouse gases this will create a new set of incentives for utilities to obtain cost recovery for prudent investment and energy efficiency have an earnings opportunity tied to verif success in delivering cost effective energy savings and will not under or over recover authorized six again this is from the edison electric institute the american gas and the an r d c you're not going to get a broad coalition i yield to i just want to i will oh my friend mr barton to understand something about decoupling when you were a consumer in a dick up old utility environment like we have in many states today but not all of them when you pay your electrical bills you don't get just watts of energy you also are buying energy services from the ality so you've got to think what you're buying from the utility is now not just watts which  enormous waste because there's no incentive to save then you're also getting back from utility a new service an audit of your home insulation clean efficient windows non leaky doors so even though you might see the same you're getting services and watts that's why this has been so spectacularly well embrace by the communities where it has been implemented including california and there's zero political opposition to it in that state and i'll tell you no the reason because states have done this all just a california example they avoided having to build six to ten new coal fired plants in california with the attendant cost of those new plants so that's why this makes economic sense like you all time has expired the clerk will call harman no mr welch votes no have all members responded to the roll call right mr space space that's now and the other member wish to respond to the vote not the vote is close or the clerk will tally the  on that mr chairman the eyes were twenty and the nays are thirty three twenty eyes thirty three knows the amendments not agreed to mr chairman before we go any further we have a very we have ten more minutes before the two hour time limit is up on this title and then we have three more where we are going to allot two hours each so that would be six more hours out obviously no one wants to be here that long but we're prepared to be here that long let's let's figure out how many members wish insist on offering amendments to this thread on the energy title mr chairman i would once we poll the members on him and he have a mimesis i would hope that we could then agree on a time for each amendment to be fully debated so much on each time so that our members get their most important three four five just the energy part five members have five amendments that then it seems to me that if we're going to do five amendments in such a short period of time let's have two on each side two minutes on each side of each amendment and i'd also ask further rather than go to roll call votes on each amendment that the roll call votes be held  be rolled at the end of that period i want to greta than you will not agree to not going to rolling votes we've never done that in the committee but i will agree on a time on each him him and i think that's fair ok two minutes on each side if members insist on a roll call votes will proceed to roll call votes but members may want to make their points and have a voice vote or even a show of hands rather than take the time for roll call votes estimate would be based upon the agreement reached well we're talking about fifty well that's a lot of time that we're talking about four times twenty twenty more minutes that's eighty minutes that's not this is a jobs a stimulus bill we passed in this committee didn't get to the floor h r sixty two to fifty eight the carbon capture and storage early deployment act it may have never made it to the floor all this would do especially on power plants that have coal gasification facilities they're being built right now and that this is the first of many pro coal votes that i will be offering in this congress this if you want low cost power and you support coal you need to use the money in the stimulus bill to incentivize the laying of pipelines move the carbon to either long term geological storage or advanced oil recovery there is interest in the gulf coast to use this technology to recover more crude oil and with that all agreed that there has to be significant funding for carbon capture and sequestration research and as a result in another part of the stimulus bill there is two point four billion dollars for having capture and sequestration research and development this is a section that goes to renewables so all we're really asking here is that you render to the renewables their section even as we will render to a common capture and sequestration and coal there section which is two point four billion which i wholeheartedly support as do all of us we realize that we cannot solve the problem unless we have a  we would ask you please not to have this program be be used as well for that because we're trying to again put together a broad based program and  gordon gordon no mr rush of all members responded to the to the role any member wish to respond to the roll that has not yet responded to the rule any member wished to change his or her vote section six zero zero one and two to read as follows to the state will implement a plan without objection the amendment will be considered as read and gentleman from florida is recognized to talk about as a member for two minutes thank you very much you know when you have these m m i to give an overview for my colleagues basically what this is is sort of can be thought of this way in the state of florida we worry about hurricanes in california they might worry about earthquakes every state has a building code a commercial building code and respective residential building codes and many state legislatures have just passed a code to enforce that is because you year for that state and as it turns out in the bill that we have before us we're having a whole new national code presented which the governors are going to be asked to comply with local government authorities to accept the most recent versions which are in this bill for residential and commercial buildings so what this means is that they will not be able to get their government money their support unless they comply to this national code and again every state has already passed certain codes that are peculiar and helpful for their state so my amendment would seek to correct this by asking the states to create a plan for implementing and forcing the respective residential commercial building code that is likely to ensure that at least ninety percent of the new and renovated residential commercial buildings space will meet the state's chosen standards within eight years after the an act of this so basically i'm saying let the states decide and let them have their code which is suited for individual states homeowners understand the financial sense in making their homes more energy efficient through high tech insulation better windows more efficient heating cooling system solar panels like they do in florida do we want to have washington to set up a national code which is going to increase the cost and ask all the state legislatures to come up with a brand new regulation when they've already already have passed and developed their own very simple mr chairman to let the states comply in their in their own perspective ways which in many cases particularly in our state i think is suitable terminal so my reservation time has expired the generally from colorado withdraws her point of order the chair recognize themselves for two minutes to oppose the amendment and the reason i oppose the amendment is that the underlying print has the secretary doing all he can to get the state to try the governor to try to get a code in place and to enforce it this amendment however says that the states chosen standards within  the chair this is really a guiding amendment what we're trying to do here is to create a set of incentives in the bill that gives goodies to the states and what we're saying here is that  five buildings that is one hundred eighty five building standards but we're looking at current standards that's what we're asking for in the legislation because if there are benefits to be derived they should be some standard which is there so this is a tolerant standard and not something that can be selected albatros early which rather than the dancing undermines our goal of ensuring that the buildings in the united states where forty percent of all energy is consumed are allowed to be built understand it's that are ten twenty years old so that's all we're really asking for it's a standard that is accepted by the industry and so it's a very simple process that's in the legislation and we urge a no vote on the stearns amendment reclaiming my time i we have a final ok all those in favor of the stars amendment will raise your hand and the clerk will count reserve a point of order the clerk will report the amendment without objection would be considered as read and the gentleman is recognized for his two minutes i think very much mr chairman or reason join us for a service department of energy report projects there are over one point three billion dry tons of biomass potential according to the report this enough to produce biofuels sufficient to report displace thirty percent or more of the us as current petroleum consumption about one quarter of that total or roughly four hundred million dry tons of biomass could be produced in a sustainable manner from all forests and range lands current law r f s two will exclude the use of biomass from one hundred ninety million acres of public lands and seventy three million acres of national forest service recognition for what purpose chairman i'll insist on my point of order gentle lady will the point of the weldon amendment is not germane because it meant the clean air act which is not before the committee today it addresses a regulatory the last page of the amendment you'll find it also impacts the energy independence and security of act two thousand and seven which i believe does give it germane to the measure that we're dealing with today because it goes back to the zero seven act barton and also point out we just adopted a baldwin amendment that deals with greenhouse gas emissions lifecycle standards being promulgated by the environmental protection agency in the then there was an amendment you obviously once we establish the renewable electricity needs to be transmitted this helps further clarify and refine define the transmission that's already in this energy copy management amendment what this encourages is a an essence a the money be used as a lending pool a bridge loan of sorts also encourages those to be eligible for this that as they build their renewable fuels electrical generation facilities usually out in the middle of  nowhere this says that the transmission lines have to be at least one hundred miles long to be eligible in states like iowa and nebraska that's pretty normal but this also encourages that they use or when they're building out their transmission lines with the electrical generation project that they use a higher capacity transmission lines whether it's the newly developed high capacity that can carry more electricity without losing as much or or simply over build because what you want to be able to do with those solar farms or wind farms is that as technology advances that pretty close but that's the overall philosophy and summary of that amendments all yield back thank you mr terry chairman gentle lady from colorado chairman regrettably i will again have to insist on my point of order  amendment addresses several areas which are not in the matters before us at this moment three in particular number one amends the federal power act which is not in the bill number two it sets up a regulatory is made her arguments asserting that point of order well i know the outcome of this but i wholeheartedly object i mean we've got a transmission line aspect of this bill this simply refined so this is out of order i think everything else is not in the transmission line aspect of it we're just getting railroaded on this one now mr chairman it's mr barton first i want to say to my good friend from colorado picky picky picky you know if the underlying concept is good let's find a way to use the obama language and share the love let's try to make this happen let's secondly i'm a little bit more seriously i do want to reinforce  what the author of the amendment just just talked about you can do some of the things the underlying bill wants to do if we don't have improved transmission siting provisions in access and while i have i have some some policy problems with the gentleman's amendment the cost of and things like that i do think because of the subject it should be real german what it it would repeal section five twenty six of the energy independence and security act of two thousand and seven as chairman in these difficult times the federal government should be promoting the development of all types of alternative fuels that could be both energy and cost efficient example i applaud the work done by nasa in this field currently nasser is partnering with the air force an aggressive research you can vote convert abundant domestic energy sources coal natural states that could be extracted in an environmentally friendly way unfortunate mr chairman section five twenty six of the energy independence and security act two thousand and seven prohibits all federal agencies from contracting for alternative fuels that have even one scintilla more carbon footprint than conventional petroleum sources this section of law prevents the federal government particular department of defense from cultivating the clean carbon capture technologies that nasa is currently researching this innovation would allow the military to lead the effort to become less dependent on foreign sources by utilizing abundant domestic resources to develop alternative fuels additionally this research could also help the struggling commercial airline industry with its own fuel costs i genuinely believe that the federal government needs to take the lead in developing alternative fuels the type of innovation that could help stimulate the economy within the energy industry are currently being stifle bass section five twenty six regrettably at a time when both the federal government and the american people can least afford it so mr chairman this amendment would restore innovation that could lead us do wish in this committee that we had jurisdiction over the entire federal government fence department over every other agency but we do not and as a result this amendment is non  but it is again it's an important point but it just does not unfortunately fit within the confines of the legislation which we have before us today within the jurisdiction of the commerce committee so i have to raise the point of order this gentleman from massachusetts would yield to me for just a second with within the amendment the nature of a substitute by the chairman under section five zero zero one technical corrections to the energy independence and security at the two thousand and seven clearly this is a technical correction to i applaud provision and that act and and therefore i feel that it is germane and i am for and i appreciate the gentleman's interpretation and technically it is a correction but it also is technically beyond the reach of this committee to be able to raise it to be able to affect all of the other agencies which are not within the jurisdiction of the committee and so i have to not it actually meets and interesting animal well knows we're going to prepare a manager's amendment to go to the floor or the majority will prepare it and hopefully some consultation with the minority in that preparation if the majority is supportive of the gentleman's underlying theory it would be pot simple to put something in to what goes to the floor but you won't have a jermaine's test there is the gym unwilling to at least look into that if the substance and i have no idea about the substance at this moment but if there's no problem with the substance and we have a manager's amendment i would not object to trying to least discuss discuss it and see if it could fit into a minute well i thank the chairman for you the that concludes all of the amendments to this committee print the vote down comes on the amendment in the nature of a substitute as amended all those in favor of the substitute and voted vote i know i think that those have it but if the gentleman will permit by unanimous consent we will vote on the final passage of the title and considers the final passage of a considered immature nature of a substitute as amended adopted by the committee without objection that will be the order now the vote comes on reporting out the  mr space i tabulate the votes and report them  some of the amendments to this title which i chose not to offer for reasons of time to allow other members offer their amendments are in fact just technical in nature if mr is a ranking member is correct it is in your intention to prepare a committee mark i guess the purpose of my question is read a manager's amendment in a matters amendment would you be willing to consider technical amendments which are not substantive but which would clarify at least to review them for possible consideration and that mark the chair would certainly be willing to reach to consider any technical amendments if there's no substantive objection to them and there is a manager's amendment which i hope we'll have the opportunity to present we will incorporate them since i'm probably not could have a brief ten minute caucus and let your side caucus the m e m in that you have and let my side caucus so perhaps we could get time agreements which are the most important amendments to be debated so that we the chair i think is called up the committee print concerning health information technology without objection the committee print will be considered as read  nature of a substitute changes the mr chairman chairman yes have we had this available to us yes when did we have this i believe so reflect our gentleman's agreement on amendments that are going to be offered and specifically does it does it provide germane is for the for the gain gr a substitute which has i believe been shared with you was our first of the nature of a substitute it's the one to which all amendments have been drafted is that correct that's correct ok if they're not to which i've already to yes we are also a green because of your agreement to put that text into as the basics to be considered for amendment that we will pare down the number of amendments that we are going to offer and on each amendment we will only have a debate of two minutes on each side that's correct and we are preparing to make sure that both sides have all the amendments and  so that members will know which amendments are going to be i would be helpful so where we are in agreement mr chairman and i withdraw my reservation so without objection the amendment the nature of a substitute will be considered as read the  the title is amended contains many essential policies that will allow this country to fully realize the promise of health information technology exchange including improvements in health reductions in disease improve patient safety and without objection my full statement will be made part of the record outlining the amendment in the nature of a substitute we ha yes gentleman status parliamentary inquiry you are beginning to address what i believe is title four have we skipped over title three where on the health information technology print which is so you going to four before you get to three i guess so i just want to be sure we have a an amendment that's been agreed to that we will have but we're trying to get that amendment together mr barton who has amendments on your side we'll consider them prepared to proceed discretion and if you're not seeking to consider them in block but separately we want two minutes four minutes of debate on which field to recognize you you have an amendment at the desk without objection your amendment will be considered as read you recognize now for two minutes to argue for your amendment chairman waxman thank you very much and ranking member barton for working out this arrangements for us to talk about these important issues  amendment is very simple every member of the energy and commerce committee is all too familiar with the problem faced by physicians on their reimbursement rates for from medicare over the past several years each year congress has intervened and has been required to intervene in order to stop a significant reduction in physician reimbursement rates this and then that is very simple it simply takes care permanently for this physician reimbursement problem and it does so by replacing the broken payment formula the sustainable growth rate with stable annual updates based upon the medicare economic index it is time to stabilize this broken formula the physician community has been very vocal about the need to make this a permanent fix and that and that's precisely what this and then does it removes the sustainable growth right base is that the moving forward it bases the updates upon the medicare economic index which is widely statement this is the singular most important issue for the practicing physician that affects our physician workforce the ability for us to maintain a physician workforce and deliver the care for arguably our most complicated and vulnerable patients who are senior citizens i could have brought a graphic of the sustainable growth rate formula in truth i don't really understand it but the very last function on the graph means that you go back for fifteen years grab all of the savings that you should have had while we've done these temporary fixes and added on to the end that's been the problem the cost of repealing the s g r is enormous because we have to go back and capture all the savings what this amendment does is say that we're just going to reset the baseline and start all over again why is that critical well this money is not real money these dollars have already been spent they have been doled out to the doctors and doctors have used them to run their businesses it's not like this is money sitting in an account somewhere drawing interest we have incur expense but we haven't accounted for it on the books if we were bernie madoff would be sitting at home at the time of the gentleman who usually to you is expired and i know you're going to have an opportunity to speak further on this issue in your own amendment i'm sorry to cut you off but the time has expired i would just urge my colleagues to recognize that this is the most singular important issue facing the practicing physician today and maintaining a viable tradition workforce to take care of our medicare patients in the future you can't pay for performance if you don't have the doctors there to do the work so much time has expired chair will recognize himself on this amendment and express my agreement with the fact that we need to do something about the medicare physician payment formula and i'm fully committed to doing so current protections for physicians are scheduled to expire in january two thousand and ten at which point of position fee schedule will be reduced by more than twenty percent of today's level that schedule guarantees that we must revisit the physician payment system at some point this year however this vehicle is not the right place for fixing medicare physician payments making payments in medicare contingent on subsequent actions by congress is a dangerous precedent and i feel that we can have an opportunity to make a major investment in this nation's health infrastructure in this bill we can't let that be derailed by other problems in medicare i do not know how much this amendment would even cost maybe mr whitfield could give us a number on that but i don't see a pay for which would mean that is expanding the amount of money that would be spent in the stimulus bill to include the cost of the medicare physician payment formula and that would my estimate is since this is a permanent fix to the s g r that over ten years you'd basically be talking about four hundred billion dollars which is more than the entire infrastructure  package the entire infrastructure section all the roads all the bridges everything that we're doing for infrastructure in this stimulus package which of course is not before this committee is included in that i think that it's it makes no sense for us to spend that kind of money without any in depth analysis of what we're doing and we are determined you know when the health subcommittee is to proceed and address this problem but it shouldn't be part of the stimulus and i wouldn't have it substitute for all the infrastructure projects we were very careful in what we do in this bill when it comes to the health provisions to try to come up with a very specific time is expired and therefore by the time that i've used it to do you has expired all time on this amendment and my apologies to the gentleman other members which to respond to the vote any other member wish to respond to the vote if not the clerk will tally the vote what one more is coming amendment at the desk men as at the decimal be considered as read without objection and the gentleman is recognized for two minutes to speak and favors amendment and as chairman i think you had the last amendment passed this amendment would not have been necessary this is a much more modest attempt to fix the projected twenty percent decrease in physician reimbursement that's going to happen in less than a year's time so this man would stop the cuts coming in january two thousand and ten and set a payment up date of two point seven percent following the advice of the medicare payment advisory commission and that it would set the two thousand and eleven medicare physician payment update based on the med pac recommendation formula of increases to produce an update equal to the medicare economic index and very importantly medicare beneficiaries would be protected from having their medicare part b premiums increased even though the amendment will protect physician payments from decreased creases for two years and i want my colleagues to know that all this does really is stop the decreases in payments to physicians for two years and ensure the beneficiaries will not be penalized by losing physician services but it means the physicians will be treated fairly and that a cut which was unintended and which was a result of a mistake by the congress will be avoided these increases are coming as a result of the flaws in the medicare form look created by congress and it is agreed by everyone who has looked at this that these increases rather these decreases are in fact a result of a mistake by congress which has not yet been corrected and i want you to listen to what your doctors at home are saying and i do want to yield time to the ranking member of the full committee members recognize the substance of this amendment i would just point out this woman was offered by mr dingell in two thousand and five to the deficit reduction act and twenty two democrats voted in favor of this amendment i'll yield to the ranking member mr chairman and thank you for yielding dr burgess are rising very strong support of this amendment this is the exact language that former chairman dean go offered when he was the ranking member during the deficit reduction act debate several years ago we had a lengthy debate at that time twenty two current members of this committee on the democrat side voted for it including mr waxman mr dingell and mr polonium who have strongly voted supported it is addition to to a voting for again this is the exact language of the dingell amendment offered in this very same committee approximately three years ago i strongly support the passage and i thank the gentleman from offering for offering them and i would point out mr chairman then we have when we have had a debate about paygo the new majority in this congress the limited eliminated the pay go requirement and there is no pay go language in the underlying print and i'm told there be no pay go on the bill that goes to the floor next week so our support of the burgess amendment gentleman's time has expired let me just inform the clerk that the wrong amendment was distributed and perhaps we can distribute this one but i think the members are fairly familiar with the intent of the amendment and what it would do chair recognizes himself in opposition to this amendment not because i oppose the amendment certainly i support it and i believe that when it had been offered previous times i voted for it we must address the medicare physician pay payment formula fully committed to doing so we know that we're looking at  expiration of the current protections for physicians payments in january two thousand and ten so we have to address it but this is not the vehicle or the right place for fixing the medicare physician payments and making payments in medicare contingent on subsequent actions by congress is a dangerous precedent we have an opportunity to make a major investment in this nation's health infrastructure in this bill we can't let that be derailed by other problems in medicare as serious as they to vote this amendment down so we can address it at some other time this trip alone you want to add any more but just again agree with you mr chairman i mean obviously we want to address this and we intend to you know hearings a attention to it over the rest of the year but again you know this the health portions of the stimulus package are a package are carefully tailored to deal with the immediate problems and those are you know people that don't have health insurance the states that you know need to cover medicaid patients because the lack of health insurance for people are unemployed and you know most of the money in this bill goes for those purposes which are immediate needs and this is something that we have time to address and is not the immediate need at the vote on this amendment and we'd like to ask the clerk to please call a get no this is caps this is caps now mr doyle ms harman is harman no there are members on the other side  have all members responded to the vote thank you and i'm of course very disappointed that the two amendments that were just voted on did not pass that be and mr whitfield and dr burgess i think they're both very important members and i can assure you as a physician member of the that what we're concerned here is getting more people access to care while they're darn sure not going to have access to care of all the physicians drop out of medicare maybe to go to which doctors i'm really not sure but my men met mr chairman is a very simple straightforward and it's one that has certainly been contingent in the past on passage about all the legislation because it is simply a one year fix it holds the dagoes harmless and in freeze the reimbursement right at two thousand and nine levels for two thousand and ten no updates no increase whatsoever it just simply freezes at two two thousand and nine levels and we don't need once again mr chairman to wite the last minute to do that as we have done over the last several several million for the national mall including the reseeding i can think of few things are more important my district in making sure seniors have access to health care which they're now finding very problematic to get access because of this underlyin issue and this congress needs to step up and fix it would have been best done in the last two amendments but certainly this is our last great hope but this is about health care for seniors gentlemens deals back the balance of his time the chair reimbursement under medicare it's an issue that we all can support but unfortunately this is not the bill where we can support it will have to do it in legislation later this year and i regret that doctors have been pushed into the perils of pauline each year wondering whether they're going to fall off a cliff and have an automatic reduction in their reimbursement rates which is by the way one of the reasons i voted against the balance budget act which had projected cuts in medicare that i knew were unsustainable we have a very difficult job now to figure out how to get a permanent fix for the fis position the reimbursement  somebody said it's going to cost four hundred billion dollars that's a lot of money even in the context of the way we're talking about money for bailouts and stimulus and everything else but we're going to have to figure out a way to do it but not in the midst german if you will yield to me for just a nice piece with all due respect mr chairman i want why not this bill if not this bill what bill i mean how is this different from any of the fix that we've done in the past where it's tacked on in the last minute to some of the vehicle if you will some of the legislation if not now when and why not now if not now when and if not us who is the way the expression goes and i sympathize with the statement but this bill which has been offered at the has states it's supported by the leaders in the house and the senate has certain constraints on it in the amount of money that they've allocated for us to to spend for a stimulus purpose and they want that bil as quickly as possible so we will have to do it another piece of legislation my time is expired we'll proceed to a vote so i understand that gentleman is willing to have a vote with a show of hands is that correct all those in favor of the amendment will please raise your hand in the clinical count all members that want to vote be sure to be in the room every complete account of what was in favor them of all those opposed to the men please raise your hand title i believe it's number twenty two i wouldn't swear to that but i think it's twenty two recognized to explain as a member and mr chairman very briefly this this image is preserves the option of our constituents who wish to go to a hospital that is owned and operated by physicians most of the hospitals in this country there were started in the very beginning of our nation's history were hospitals or clinics that were started in operated by physicians for some reason the new democrat majority has decided to try to obliterate one of the areas of the health care sector that is being most innovative most cost effective and most quality conscious so all this amendment does mr chairman is simply reserved the right of our constituents to go to a hospital that is owned by physicians it would not it would allow for those people that receive medicare to be have medicare reimburses services that are provided by these physician own really important concept and mr chairman with your permission i will submit for the record a an extremely insightful article that was published in health affairs sports twenty four two thousand and eight written by a member of this committee which detailed why this concept is so important there is nothing like the pride of ownership and for a suspicion known hospital or a big story surgery center you want things done right because after all it's yours one of the things that we have the least amount of in practice of medicine is time and we are able to control the time much better in a able torrie surgery center a physician owned hospital as opposed to an investor owned hospital that i won't mention of the initials but you can imagine who that might be so i do want to submit this for the record if there's no objection and i strongly encourage encourage support of this amendment without objection the full statement will be made part of the record the chair recognizes him south in opposition to the amendment this would repeal provision in the children's health insurance program reauthorization before it even clears both houses and that bill closes a loophole in medicare law that allows physicians to refer patien to themselves the current physician's self referral law includes an exception that allows for ownership in the whole hospital but explicitly prohibits ownership in a subdivision of a hospital and the  a child health insurance provision would not prohibit physician ownership but it would simply ensure that those physicians could not refer their patients to hospitals in which they have an ownership interest if a physician can benefit financially by referring patients to an entity in which he or she has an ownership interest there's clearly a conflict of interest that's why this provision that the them it seeks to repeal was strongly supported by the american hospital association and the federation of american hospitals provision in chip rug which save two hundred sixty million dollars over five and one point two four million billion over ten reflecting b s and med pac's assessment that the incentives inherent in these ownership arrangements increase the use of health care services so i would urge members to oppose this amendment time to chairman i if i could just add i mean this the chip bill which you know includes this pay for which essentially would be repealed that this went first was passed by over two thirds majority in the house last week two weeks ago and it had a lot of republican support so you know i think it doesn't make any sense to undermine what the house has already said they support including a lot of republicans you'll back the time has expired all those who are for the cement we're going to do up by a roll call but a show of hands all those for the amendment please raise your hand the clerk will tally those opposed to the amendment please raise your hand and thirty nine and eyes and thirty knows and that might be change here or there but not enough to make a difference by members who would like to been clear on record a member is not agreed to that completes the read the gentleman is recognized for two minutes to explain this and thank you mr chairman the amendment eliminates the provision in the bill that would give state's attorney general the ability to bring a civil action as a means of enforcing the hipaa privacy rule the provision is unnecessary states have the ability to incorporate hipaa as their own state law or design different state policy law many states have done just that in addition d o j and h h s already have the authority to pursue criminal and civil enforcement of the hipaa rules which has been strengthened under the bill in fact under current law state a g s already have the ability to file a complaint with h h s on behalf of their residents if a potential violation comes to their attention worse this bill allows state a g s to contract out this work to the private trial bar whose interest is money not privacy not justice not stimulating the economy furthermore this provision makes the federal privacy law subject to local politics state a g s are elected officials political by nature means that this provision will result result in politically motivated lawsuits and mr chairman it's not just us and i would encourage the members to take a look at the health i t now coalition it's made up of providers consumers several other interest groups like michigan manufacturers health they're groups like cancer and heart association and let me give you just one paragraph from that letter we are concerned that allowing the state attorney general to enforce the hippo privacy rule would lead to a patchwork of inconsistent foresman actions that will disrupt a nationwide interoperable system and would cause great harm to promoting efficiency cost savings and improve care it is quite a list and without objection mr chairman i would ask that the health i t now coalition letter be made part of the official record it is the more we look at the so called stimulus bill the less stimulus we find and the more onerous that we make health i t which has the great opportunity to unleash innovation all across the united states and save lives the more difficult we make it for that to happen the less stimulus you get and certainly the less safety and security you have i would strongly encourage this body to reject the state attorney general's ability to make it more complicated than it already will be to implement a nationwide i t health system  time has expired gently withdraws her point of order reservation for point of order in the chair recognizes mr polonius opposition to the amendment mr chairman basically this provision that  specifically authorize the states turned attorney generals to enforce the federal federal privacy and security laws provides an additional layer of privacy enforcement which i think is very important it's an option on the states part it's not a requirement but i think that if we feel as i do and i think most of us do that these privacy and security provisions are important it makes sense to have the states have that option to enforce them  and without jackson general mobile submit a statement for the record in support of the amendment we're going to proceed to a roll call vote the clerk will please call the r this harmon is harmon no other members who wish to respond to the roll call dingell shooting of votes now and the other members wish to respond to the vote not the fifteen in the nasal thirty two fifteen eyes thirty two knows the members not agreed to mr blunt i thank you mr chairman it's blunt amendment number one it's the one that deals with the pharmacist and i'm going to read the amendment because it's so quick it just says nothing under this subtitle shall prevent a pharmacist from collecting and sharing information with patients in order to reduce medication errors and improve patient safety mr chairman the new rules in this bill concerning electronic health records may actually discourage implementation of new technologies the bill without says without prior written consent health care providers including pharmacist may not be able to use electronic health care or medical records to engage in quote health care operations and quote this could include such activities just simply recommending a generic drug drug as an alternative under the bill only people who get prior would have access to this kind of information from a pharmacist the public health care products in the pharmacist provide to patients is protocol and shouldn't be hindered the amendment does not alter the privacy and consent provisions it will allow health care well out pharmacist to continue to collect and share information with all patients in order to make sure they have the most accurate and up to date information about treatment and again this very straightforward it just simply says that nothing shall prohibit a pharmacist from collecting and sharing information with patients in order to reduce medical cation errors and improve public safety mr chairman gentleman yield back the balance of his recognize mr polonius opposition to the amount mr chairman basically what the and the lying bill does is prohibit a provider from getting director in direct payment in exchange for using protected health information  the bill as it stands doesn't preclude you know the pharmacist from making these communications a pharmacy pharmacist can send a refill reminder to any and all their patients without an authorization if they believe it's best for their treatment that they can't be paid by a third party that does not necessarily have the patient's best interests at heart and providers can request patient authorization to use their information for marketing efforts if they want to so i think that the bottom line is we're just trying to prevent somebody from being paid by a third party when it's not in the in the patient's best interests and ice and i think that's a proper balance here to allow these communications when it's in the best interest of the patient for treatment but not when the pharmacists or others are going to use it as a marketing tool and they're going to get paid to to to provide that information so i would urge opposition to with each other so much of the time and whatever your explanation of this i don't think squared away with what in the language i think we're headed religious pharmacists how do you leap frog from you know they're collecting and sharing information with pace and patients to reduce medical medication errors and improve the safety for them how does that leapfrog into the advertising that you're talking about what do you know how does it morph into that gentleman yield to me i don't think it i think the it's a pharmacist wants to have communications with the with the client or patient there's no problem with that what is the problem is this if a drug company goes to the pharmacist and said give me the  prescription drug refill reminders that you're sending to your patients who are taking a particular drug so that we can then send a retirement to them to take a different drug and so it's a third party that  intervenes if you have if your pharmacist says information about the drugs you're taking that shouldn't be given to anybody else and so this is an affair with the designers and the pharmacist patient relationship it precludes a third party from getting involved but it doesn't lay that foundation in the amendment itself it doesn't i mean the way i'm reading no there's a there's barely four lines here nothing under the subtitle shall prevent a pharmacist a pharmacist doesn't say the drug companies or anybody should prevent the pharmacist from collecting and sharing information with patients in order to reduce medication errors and improve patient safety  objection i thank the chairman the nothing in that language allows pharmacists to share with outside parties or just allows them to share with patients i mean it's very straightforward if mr plone is correct and the bill prohibits pharmacist from entering into some sort of of paid relationship or relationship where they make money that's fine all worse all this amendment says is that this doesn't prohibit pharmacist from communicating information with patients it doesn't address community that information with drug companies maybe they are prohibited from some sort of third party pay but this unless the patient was third party paying them there shouldn't prohibit that and i'd  if i feel the chairman chairman barney this would end along with mr markey i am one of the strongest patient advocate privacy rights in this congress i support this amendment this does not deal with marketing to outside it says sharing information with the patient that is a good thing not a bad thing we should support this mr polow has one but my concern if this language in the amendment is a added is that it could be interpreted to say that you can share this information even if you are getting paid and you don't need the u s you don't need the authorization from the from the patient and other words it would directly repeal and say ok if the third party now decides that they want to share this information and pay me i can do it without the prior authorization of the patient and i don't really understand you want what you'd be getting at in less that was the purpose of this amendment that seems to be the purpose of  gentleman still has my concern mr chairman if you will is that this directly undermines and would say that the pharmacist could now get paid and you know share this information without the prior authorization of the patient and it therefore would directly repeal what we have in the underlying bill that's how i would read this amendment just blown if you would let me let me it seems that some confusion and maybe we're arguing about something legitimate maybe we're not would you just pull it back and we'll come back to it believe it's listed as a rogers amendment one one  large ability alone to do that really what happened i think in a rush here is that it would this provision would require a pharmacy to receive prior authorization before sending refill reminders to a patient and if and i think in our rush to do something good we may have overstepped a little bit and i think pharmacies and providers took a look at this language and said well that's your you're not allowing us to do something that will have a direct impact on patient health no medications is a significant problem in the united states three out of four americans report not always taking their prescription medication as directed this would prohibit them from contacting those patients and trying to remind them you know how you're doing  your medicine you need to keep taking your medicine pharmacy should be allowed to communicate with patients regarding their prescriptions and treatment plans so mr chairman i i i don't want to go on to make a big deal of this i do i do think that it's a big deal to pharmacies it's a big deal to providers and i would hope that we could work something out on this even in the in the amendment and i do know that there are there are significant support of that on both sides of the aisle so your discretion mr chairman i'll i'll take direction from you on how you'd like to do that but i do believe that there's something that we can compromise on here as mr chairman would throw my point of order against amendment it is germane point of order has been withdrawn and  it's a gentleman would permit why don't we pull this one back sir and consider it together with the other one and see if if there's a dispute or not if we can resolve it great mr chairman i will do that without objection that amendment will be withdrawn i thank the chairman very much my amendment would add an additional security requirement that i believe is important to safeguard consumers personal health information my m m it would simply mandate the protection of a patient's medical information when it's transmitted through the help i t infrastructure created under the bill all when it's removed from these health i t systems and put on mobile devices such as to the ability to use a standard that is equal to or better than the standard in existence so that we don't lock something in i mean there's some concern that this may be this language may be too rigid that it if the gentleman would yield to me my intention is that it not mandate a particular technology be used to make the data unreadable only that the technology doesn't accomplish that goal so to the jackson the amendment will be considered as read and distributed and the judge has recognized for two minutes thank you mr chairman so many of us have been supportive of health information technology when we recognize that it saves lives and saves money one of the things we have to understand is that this bill is supposed to be about helping our economy and creating jobs a lot of the technology work and the software support is done in this country but very often is also farmed out to other countries so you may have a hospital the united states working there health information technology and much of the work may be done in other nations find people as other nations but we're spending twenty billion dollars on this our goal is to create american jobs this amendment to buy american clause it does not  affect companies that are owned foreign but just the work that is done in the united states i urge my colleagues to support this recognizing also that very often when any of us contact companies perhaps we have software issues or problems our computers or credit card issues we find ourselves frequently talking to folks across the globe as opposed to in other parts united states where the gentleman you were prepared to accept your amendment thing was stern with that i yield back my time  thank you it ensures that the great promise of the in efforts to save valuable health care dollars reduce medical errors and advance patient centered medical care also includes reducing health inequities by inserting reducing health disparities and section three zero zero one page eight line fourteen these inequities not only cost the health care the but also leave millions of otherwise hardworking americans in poor health and more likely to be sick and die prematurely doing what should be their most productive years the amendment also ensures that as the h i t policy committee makes recommendations about bolstering patient privacy strengthening the infrastructure and expanding h i d implementation use and coordination that they also make recommendations about utilizing h i t to reduce health disparities and that's by inserting by reducing health disparities on page twenty one line four of section three thousand three zero zero two and the research on health disparities is overwhelming by the institute of medicine department of health and human services and many reputable think tanks and it would be we have this opportunity to not only modernize our health care system but to also ensure that health equity is a component of the system and we cannot pass up that opportunity i want to thank you chairman waxman for allowing me to offer this amendment and i urge my colleagues to support it the gentle lady will yield to me i would urge that members adopt this and both a majority of the minority staff have reviewed it i want to commend you on this amendment i think is a very important one and i would urge all members to accept it if there is no further discussion all those in favor and i think the chairman this amendment would create an exemption to stark and a kickback clause that currently prevent hospitals and other groups from sharing technology with physicians hospitals and doctors practices are prohibited from contracting with one another for the purposes of technology or software transfer while recent health and human service regulations allow hospitals to donate equipment to doctors offices they're still prohibited from entering into long term contractual relationships to develop the purposes of maintaining upgrading equipment and software over time and any physician's office who's ever gone to electronic medical records will tell you it's not just the cost of the equipment up front but it's also the cost of training personnel and the cost of maintaining the software over time that is adds to the expense providing a narrow exception under the federal antitrust law for the ability of healthcare providers to work off of similar technological platforms make sound business sense and will improve the adoption of health information technology mr chairman recently i to the common will fund a symposium that they have every year we heard from a large medical practice in western pennsylvania and they would like very much to be able to put technology in all of their doctors offices but they are prohibited from doing so under the star clause as a consequence they've gone to a web based portal but then they get into difficulty with the privacy aspects so we've really constrained the private sector from moving ahead with technology that we've told them we've told them to develop coordination in health care we all talk about it and we say it leads to better health outcomes and if we're focusing on how great or information technology deployment can revolutionary and i had dinner at my texas colleague we get a copy of the talk about revolutionizing the practice of medicine with information technology we should eliminate the legal barriers to greater coordination of care this is going to be critical this amendment provides for a narrow exception under a law and it is cost free as we pour money into th sector of the economy i mean it is literally raining money today our dollar will go so much further it medical practices hospital and clinics and jointly share in the cost of capital of the systems that now you'll back to balance my time gentlemen time has expired as i understand it mr burgess had an amendment before the wrong amendment was passed out and that's this amendment so we will try the make copies available for members who wish to have copies of this amendment  and mr burt burgess has offered his personal copy and he's willing to autograph it when there was in the republican majority congress a few years ago an effort to move an h t bills for this committee and the source of funding was basically to loosen the stark and anti kickback and anti for protections i don't believe that that's an effective means of paying or actually producing a good h i t bill i mean what we're doing today and i think it's very significant in the underlying bill is we're finding  t through medicare and medicaid and we're actually providing the money upfront to do this we have direct funding for health i t not these you know fraud loop holes that essentially have been talked about in the past and my fear is that you're just you know that this is not the proper way to go about it i i think it's important to continue the stark and anti kickback anti for protections not use them as a way of paying for the bill particularly now that we have the opportunity with this economic stimulus package to actually pay directly to to to proceed forward with these great provisions so i would urge our member members to oppose this amendment it again it goes back to what the republican majority was trying to do before and i i think it's not the proper way to proceed when you're trying to really effectively do a good h i t program will generally i would yield to mr waxman the the the underlying bill provides billions of dollars to doctors hospitals and others to incentivize the adoption of an electronic health record and electronic health record allows providers to communicate with each other even with providers across the country c m s n l y g promulgated appropriately tailored exceptions to the stark anti kickback laws in two thousand and six these exemptions permit the donation of health information technology as long as technology permits electronic communication among recipients the amendment emphasizes loosening stark anti kickback anti fraud protections and these  for thirty additional seconds well first off this bill before us today no money comes to anyone before two thousand and eleven so that's a that's a big problem there's not a lot of immediacy to this bill and honestly this costs nothing and it's not a question of it's a question of being able to leverage we all admit it's raining money right now there's no stop to the amount of dollars that are being pumped forward why not leverage those dollars so they spent more efficiently one of the things we could do is define privacy once and for all and not change our minds every thirty minutes mr rogers tried that you knocked it down the other thing we could do is relax some of the regulatory framework these are thirty year old laws gentlemen have no place in the twenty first century gentleman's time has expired  i won't elaborate further on that that we are spending two billion dollars right away on under this bill we will now proceed to a vote how does the job of the wish to have this vote taken you want a roll call mr stern the bill never move forward but what this does it's about the accounting of disclosures and under hipaa individuals are currently entitled to an accounting of certain non routine disclosures of their protected health information that's a good thing provided providers are required to compile a list of these disclosures at the patient's request also a good thing however there is an important exception for treatment payment and health care operations function unfortunately this bill i hope inadvertently removes that exception providers conduct millions of legitimate justifiable disclosures each year for the purposes of treatment and payment you have to do it i mean it's there's no other way the system works and if you can imagine as an example if a doctor is looking for a second opinion he sends an e mail according to this new law he'd have to find a way or she would have to find a way to account for that e mail for three years i mean it is very onerous and it's really not protecting the patient to the degree i think we all agree should happen but it does add  this and onerous regime on these providers to do something that i think we can all agree should protect them maybe not in this way the information by the way is rarely if ever requested give an example of a large one of the largest pharmacies benefit mad your managers up p b m covering sixty million patients has only received six of these very specific requests over ten years sixty million patients six requests over ten years and we're going to create this whole regime of them having to require every disclosure when somebody says this is how much money you owe they have to now account for that as a disclosure i really think that if we rational if we go  where we're trying to protect the patient this doesn't help actually it's going to add lots of costs lots of confusion and it's quite clear does not benefit the patient given the number of requests they receive so mr chairman i'm in the as i said the last chairman said that we would work this out i would your your desires here i will withdraw if you want to work work this out i'd be happy to do that i think we'd find lots of common ground on this amendment or you could accept it that would be good to the gentleman we'll to me i think the amendment makes it more complex and i don't quite see a way to work it out i'm sorry to tell you that so we're going to have to oppose the amendment when i recognize mr him and i think that actually the gentleman's amendment would make it more difficult to separate out when a disclosure is made for treatment person purposes versus payment purposes versus health care operations  basically it's going to have require more work for providers to separate separate out the disclosure for these different purposes you know obviously transparency is very important if you want to ensure the privacy and security of the individuals health information and all this underlying bill does is require that the entities maintain an order trail of one of patient's information was disclosed and that could be for treatment payment or health care operations  i don't see the i think it would just be a lot more difficult and allow for less transparency if you basically said that we're not going to do this for treatment or payment purposes only for the health care operations category so i don't see again i agree with the chairman that there's really no way to work it out because we want to provide this transparency for all these for what the gentleman yield district i mean it with the what you're talking about though doesn't exist today they have to do the audit trail  other than treatment and payment disclosures but we're now what you're telling them to do is every time you provide that treatment and payment you have to call it audit trail for every one of those so called disclosures that happens millions of times every single day in the administration of our health care system and that's why pharmacists disagree with you providers disagree with you ensure insurers disagree with you that that they look at this and say jesus is a a huge huge ask very expensive for no gain to the patient so i would argue it really keeps in place what is a good audit trail today and they should have to disclose or audit those disclosures when it  offered and entities maintain an audit trail of a patient's information through an electronic health record including for treatment payment or health care operations such as quality assessment or medical review and this change the bill only applies to disclosures from the electronic health record it only requires data that can be automated automatic automated become active about those disclosures so i would join you in opposition again that will have to track the amendments not agree to would draw that however we were also understand that you would work with us on some of these amendments well i'm always certainly very willing and eager to do that i am always available to work with us i would say i will throw that to jim but i think there's this is something we absolutely have to come to a conclusion in and everybody in the community disagrees with your assessment of what it will ask them to do versus the benefit of the patient so i would drop my request for a roll call vote under the condition that you work with us mr chairman i certainly will promise to work with you clearly in no hurry mr chairman general lady from colorado reserve a point of order yes or board of orders been reserved amendment offered by mr burgess of texas and at the end of the section one hundred four eight of the social security act added by section forty three eleven and of the title for the following additional limitations notwithstanding the previously present without objection the reading of the amendment would be dispensed with as a job is recognized for two minutes and for this amendment is all about priorities we've agreed that we need to lay a rapid groundwork for rapid deployment of information technology in health care medicare is near the breaking point but the bill we have before us today is missed an opportunity to shore up medicare and again we're talking about stabilizing provider payment rates we all hear about new medicare beneficiaries finding it difficult to locate a doctor that will take medicare when seniors relocate it can be a struggle for them to find a doctor is even willing to see them this is all because physicians around the country are starting to realize that medicare is an unstable payer subject to the whims of political will and influence and they're doing what they have to do to protect their small businesses we've talked about it before the sustainable growth rate formula is the mechanism that cuts medicare payments on nearly an annual basis and it's flawed and it must be eliminated i know this isn't an easy task or one that we can do quickly but i think congress can fix this problem and if we don't we'll see medicare access problems faster and physicians will flee the program in droves it isn't good for seniors it isn't good for the country and ultimately it's not good for the congress because these are your constituents who will be upset this amendment merely states that should the sustainable growth rate formula still control medicare payments and eleven the secretary may not make any medicare health information technology incentive payments authorized under the bill so it's an incentive for us to get busy and get the s g r repealed a vote against this amendment will be a vote in favor of the status quo a vote for this amendment will give medicare patients and physicians the hope that change is indeed right around the corner back when i withdraw my reservation that was genera withdrawal reservations and this amendment is similar to other amendments it's just another way of phrasing it to require that we update the physician fee schedule and if we don't then doctors won't get their bonuses on health i and i think that's just not doesn't make a lot of sense to say the doctors can't participate and get bonuses for doing what they always hope they do on health technology unless we give doctors and upgraded their physician free reimbursements which we hope to do it some later time so i would urge opposition to this amendment will generally yield for one additional point i would just state that under the health i must have a soft spot for you does it say we are committed to fixing this and we're so serious about it we're going to put a backstop where we will not go past twenty eleven before this s t r problem is fixed and i understand what you're trying to do i just don't think we ought to do it in this bill and we ought to solve the of georgia without objection the committee be amendment will be considered is read the general lady for colorado reserves a point of order which it appears she may assert gentleman from georgia mr getting these recognized for two minutes mr chairman i thank you i do intend to withdraw the amendment i think my colleagues on the other side of the al know that i have worked very closely with some of them on a chatty electronic medical records in particular  incentive in regard to the grants and everything that's provided to some doctors and some hospitals they're going to be far far too many that just simply can't afford the sticker shock of electronic medical records so this amendment would allow them to expand would allow us to expand section one seventy nine allow or else code so that a group of physicians could take up to two hundred fifty thousand dollars deduction in the year that they purchased the hardware software instructional whatever package for electronic medical records and it will expand the amount of money they could ride all found in a five year window to  accord an accord on mt but again i think the ways and means committee will probably take up this i hope that chairman stark and ranking member or her go will will look at it as well but this basically would say allow physician groups up to two hundred fifty thousand dollars of a tax deduction in the year that they make the purchase an individual obviously would not spend that much money but whatever they spend thirty thousand or whatever because they may very well not be in line to get those grants that some of the lucky ones will get so with that i just want to make sure that all my colleagues understand what i'm trying to do i think it's a worthy thing i think that they're way way too many physicians that are not not going to buy thank you in this second amendment dub tails into the first one although i hope the gentle lady from colorado withdraw her point of what i do think this is germane basically in this bill we have both carrot and  stick to punish those who don't get on board with electronic medical records and incentivize those that do but quite honestly mr chairman and my colleagues i don't think that the incentive is enough and i think the punishment  is too much the stick is too much this amendment would simply say instead of giving them an incentive payment for electronic medical records and twenty eleven that would last five years and and fifteen automatically it would only expire when there's eighty five percent saturation or twenty eighteen as a drop dead date inside the ten year budget window  on the on the stick side those who would in two thousand and fifteen would start being penalize for not adopt an electronic medical records what we would say is that penalty would not occur until at least fifty percent adoption had occurred and then it would only last until twenty eighteen again within the ten within your budget window i know it sounds a little complex but quite honestly what i'm trying to do with this a minute mr chairman colleagues is to is to further incentivize because clearly we want i believe the rand study of a savings of one hundred sixty billion dollars a year for full adoption integration i believe that point of order mr pillow and you seek recognition yes mr chairman my concern is that the standards in the plans that we're trying to put into effect would not be eligible to be certified and we would know whether they are deserving essentially of a bonus payment by two thousand and ten and there was this was set up with the year two thousand and eleven because that is how long it was assumed in a rational way it would take to be able to get the standards in place and have those plans ready to be certified and therefore deserving of the bonus payment so that's why i would oppose the gentleman would yield on his point of order gentlemen you know there's no point of order that's been which one gentleman yield to me  also would oppose this because while that advances it advances the bonus payments we don't know what that's going to cost and without knowing what the cost will be we don't know how that affects the overall amounts in this bill and the balance in the legislation and so for that reason in addition i would urge opposition to the amendment do you know that to balance your time all time has expired on the amendment all those in favor the amendments say i i those opposed say it will have a distributed amendment offered by mr burgess of texas in title four and at the end of part two of subtitle c the following section four three one five accelerated incentive notwithstanding any other provision of this part or any amendment made by this part the secretary shall establish a method under which any incentive payments establish pursuant to the amendment made by section forty three eleven or forty three twelve shall be available to an eligible professional professional or eligible hospital respectively beginning in june two thousand  nine gentlemen the amendment is before us gentleman is recognized for two minutes thank you chairman i'll be very very brief with this bill the stimulus bill is before us is to stimulate the economy through a massive infusion of federal dollars the likes of which we've never before into the united states economy but the provisions related to health information technology incentive payments to providers and hospitals don't go into effect until two thousand and eleven so most economic projections i've read or seen have the recession say the recession that we're in now will likely be concluded by that time if we are to accelerate the payments available to providers and hospitals this new program would be more stimulative in nature and these dollars will be available much earlier than two thousand and eleven by making an early and substantial investment in health information technology we can help kick start the economy sooner rather than later which should be the intent of legislation we have before us today now ms issue noted your opening statement that we can't f burns she said this is as urgent as it comes well since it is an economic stimulus bill it would make more sense if the payments in this bill went out now as opposed to twenty eleven my members would make the medicare incentive created in this bill available in june two thousand and nine as opposed to beginning two years later and i'll yield back the balance of my time gentleman yield back the balance of this time mr mr gordon recognized for two minutes well i'm first of all very pleased that this afternoon and tonight we've established that health i t is important and that is going to save lives and money that's i think that's the good news with another analogy dr burgas we also don't want to put the horten from the horse and from the cart you might remember back in two thousand and two this congress appropriated hundreds of millions of dollars for the states to purchase electronic voting systems before the complete technical system of standards were set up and conformance tests were put in place and now you're seeing them scrap those  give you a more local analogy george washington university just built a new hospital they have a health system in the in the emergency room and they have one in the regular hospital they can't communicate and so  the reason that there was a you know you would certainly we do not want to waste money by allowing people to start buying systems before the technical standards or stablished and also that the test beds are put together so that that software  can be given for lack of better term the good housekeeping seal of approval we want to get out the door as quickly as possible there's money in this bill that helps to accelerate that process to get those standards and i would  course straight so clearly why the health information technology does not belong in a stimulus bill and i will be happy to stipulate that point that's a point i made that well first i'll reclaim my time there are billions of dollars that are being spent up front there's also by doing this it sets certainty in the private sector for them to go ahead and start hiring people getting ready for this and so it is you know money you have to do doesn't have to be spent to stimulate the private sector when they know that it's going to be coming we want to do this we want to do it right i can't imagine you know again i can't imagine that you would want doctors to be spending money on systems that may not qualify later and so much time has expired all time has expired all those are favor their members say i oppose no no and those have it the amendments not agreed to as i understand this is the last amendment that we had earlier considers of amendments that we put aside of this of a substitute as amended all those in favor of a point of inquiry mr chairman yes the amendments that we withdrew in order to work with the staff have been disposed of we'll come back to them ok all those in favor of the amendment the nature of a substitute as amended say aye i oppose no the ayes have it the members agree to now the vote comes on reporting the committee print as a all those in favor say aye aye oppose no the i's appear to have the i's have it and the motions agree to we will now move to the next committee  the chair calls up the committee print regarding health insurance assistance for the unemployed without objection the committee print will be considered as read the clerk will designate section one to open up the amended process kind of three health insurance assistance for the unemployed section three three zero zero one four title and table of contents title the chair has an amendment at the desk in the nature of a substitute and without objection the amendment will be considered as read and as base text for the purpose of amendment this amendment contains minor changes to the tax consolidates to medicaid eligibility category categories individuals are receiving unemployment benefits and and individuals have exhausted those benefits into one optional category it also means conforming technical changes the majority minority staff if provided with been provided with the text i have further statements in my comments which i would like to make part of the record in explaining this amendment the nature of a substitute the chair will now call for amendments to the amendment in the nature of a chairman mr barton i haven't a minute number thirty four today chairman jed lady from colorado reserves a point of order gentleman is offering an amendment which is at the desk the clerk will report the amendment  base texas before us has a new program that allows the federal government and the taxpayers that fund the federal government to pay the cobra premiums for people who have lost their jobs that is that is a noble idea however a puts no means test on it for example an executive with lemon brothers does make millions of dollars a year and has millions of dollars in personal assets lost their job under the basics they are eligible for cobra premium assistance under this bill i don't think that's right so i'm offering the lehman brothers amendment to the bill that simply says if you have an annual income of over one hundred thousand dollars in assets of over a million dollars you don't receive the cobra premium assistance subsidy in the basics of the bill know my concern with all this is that you know right now in this because of the situation that we face you know where people lose their job at any given time in the year and you know may find the circumstances change  dramatically that you know you might be making out with a gentleman say a hundred thousand dollars last year but then all of a sudden you're in you know january of this year and you have and you're and you lost your job and you have no money so i just think that when we start get into these you know meet these sick caps or means or assets test it really isn't appropriate given the fact that some people find themselves in a situation where they have lost their job and  you know they may not be any different than anybody else at that point in time so you know this is temporary i understand with the journalist trying to achieve but i am concerned that once you start going down this road we are going to start eliminating people who may actually need to help and i haven't seen you know i'm looking at the actual amendment here and i would be concerned that we might find people in that category generally you yeah  i think there's some strong arguments to make for a means test but i can't see how we would set up such a means test we'd have to take somebody just lost their job that's what makes them eligible for cobra and then try to figure out what their income is if you go backwards their income might have been pretty good but if you go at that moment their income may not be all that goods are lost their jobs and then you have to set up an assets test let me simply say that some of these temporary programs sometimes become permanent programs it took us one hundred years to repeal the temporary surtax on telephone service for the spanish american war so i would i would be leery of calling some of these ms harman ms harman no mr butterfield mr butterfield no mr mound song mr rush yes i'm sorry mr rush votes no of all members responded to the vote mr markey if you voted chairman reserving point of order generally from colorado reserves a point of order could you repeat the number please i'm thirty three thirty three and it was twenty five and i was thirty three you know this a minute is not necessarily a bargain and then mr nzimande could be the bernie madoff amendment because what we have here is we're asking the people that make more than a million dollars it would prevent them in fact if they had one hundred million dollars or prevent them from receiving cobra premium assistance subsidy so you know when you look at what we had in the previous of em it might have been called the lehman brothers amendment but i think this one is a bernie madoff amendment because all i'm asking is if you have an income over a million dollars and this means you know you could have fifty million one hundred million that you know the government should stand stepped in and start to pay your health insurance dollars in taxes have to pay sixty five percent of the cobra premiums for multi millionaire now mr waxman mr chairman waxman you and your colleagues really don't want to do that i know you don't i mean i know you have a lot of rich friends  but the friends you have can support you're one of them and they don't actually i'd be glad to pay my own health insurance if i got fired from this job i'm ready but it's just not right to have your party to help these people that are making so much money and to step in and say ok mr taxpayer from ocala of florida and from osceola florida you guys are going to have to pay the maid also this world with these cobra payments i mean my constituents like yours are having a very tough time and you're asking me to tax them and say ok you want to pay these rich guys on wall street it's not right so if you make a huge amount of money step up to the plate and pay for it don't ask the people of alcohol could supp amendment it prevents taxpayers from having to pay the health care bill of multi millionaires chairman i withdraw my reservation chair recognizes himself we have the problem how you try to find out people's income to set up a system to say whether they're going to be eligible for the cobra help or not now i would think that it should be as difficult to check or somebodies annual income as a million dollars or more and i don't know how that would be structured but i'll  agree to the amendment and we'll see whether we can figure out a way to structure it missed this general you accept the amendment i'm willing to accept the amendment on the condition that we'll see if it could work and if it can't work we're not going to stay with it but we'll give it a try well i think we just won one well we both could be outvoted the question now comes on the sterns millionaire amendment all those in favor of the amendments then offered by mr rogers in title three at the end of the amendment added by section three zero zero three eight to add the following effect of october one two thousand  notwithstanding any other present would move in that they might be considered read without objection the amendments considered as read there is a reservation for a point of order from the gentleman from texas and jonah from michigan mr rogers is recognized for two minutes  german as legislation creates a way for states to extend health care coverage to unemployed workers through their medicaid program and at the same time it also recognizes that premium systems is important in the cobra plan well it's important to assist unemployed workers with health coverage during a recession if we're going to do it we must provide them with meaningful access to health care my amendment would require states to give unemployed workers more options it would offer premium assistance to so unemployed workers can purchase high quality a high quality health plan that meets their needs for many states including michigan access to medicaid doesn't always mean access to good health care state medicaid programs are underfunded and provide fewer benefits meaning doctors see fewer patients there is no more heart wrenching call you will get in your office from somebody who has finally gone through the process to get on medicaid and cannot find a doctor to take them government run health care program simply can't provide the same high quality health care found in the private market and they can't keep pace with reimbursement rates by giving unemployed workers the option of choosing a plan on the private market were giving patients better access to services better plan benefits and ultimately better health outcomes and it will incentivize doctors to take medicaid patients which is absolutely critical as our unemployment rates start to creep up mr chairman i fear the for the upcoming debate on health care reform if this amendment fails is that the goal of health care reform to flaunt that you have covered everyone but ignore the broken medicaid model or is it the goal to provide everyone the opportunity to have affordable and equally important accessible health care majority has already acknowledged that premium subsidies work you've done it in the cobra plan let's do this for the medicaid patients who are eligible so that they can have the private health care option to buy in to make sure that doctors take them in states that have unemployment like michigan at ten point six percent that's right in point six percent this is crucial for them to continue to receive quality health care and i wo this is not like cobra where people can take their group plan and get and pay for it and keep it and maybe get some help so they don't have to pay their share and the employer share what the gentleman's amendment would do is to give people on medicaid people on medicaid a little amount of money and tell him to go out and buy a private policy well they're not going to be able to get a private the doctor be able to get a private group policy they're going to get a private insurance policy and if they have a disability if they have a chronic illness nobody's going to give them a policy especially for the amount of money they're going to get under a previous support as a gentleman would outline that undermines the whole idea of making sure that we have a benefit package that will be available to people under medicaid many states choose to cover those people under various kinds of managed care settings  and even through private through private managed care situations but to give them a premium and then tell them go shop around for a policy is a day they'll buy a policy that we cover some of their needs states have the flexibility now that if they want to do this they can i just don't want to put them in a straitjacket you know right now what we're really trying to do is make sure as many people are covered as possible and many many states might find that you know this kind of premium assistance program is just going to bog them down and make it more difficult for them to move ahead and cover everybody under regular medicaid so i mean i think we have to give the states that flexibility we shouldn't require this they can do it if they want to w than to do it with a gentleman you fifteen seconds gentlemen recognize the fifteen sec thing mr chairman took points it's voluntary and you put no income test in here so if you have the means you should be able to do it there's no income test you can get out you lose your job get on medicaid you can actually have a reduction your benefits when you might be able to afford a plan just given the option to do that you're removing that option from literally hundreds of thousands of workers when you come from a state like michigan you're excluding a whole bunch of people from even getting acce we're not removing it they still have the option is your amendment would require it and i think that it is not going to have an option available to them invest to the private insurance market all time is expired almost on this amendment all those are the savior of the rogers a member will say so hall votes i other members wish to respond any members risk to respond to the vote that have not yet done so i and then an offer by mr stern in section three zero zero three b to strike one hundred percent and quote and insert fifty percent moments before us the gentleman from florida is recognized for two minutes chairman i'd like to direct this amendment to mr pallone who is a subcommittee chair of health and just have sort of a talk with him your governor corps and in my governor chris probably would want a hundred percent administrative costs i agree all i'm saying keep the status quo that is when it comes to reimbursing states for administrative costs make sure the states have something in the game some skin in the game some money in the game so that they're involved too and also make sure the federal government has some say so when we're trying to drive down costs for medicaid so my amendment returns what is in the bill to what the status quo is it forces the states to share fifty percent of administrative cost of medicaid buy in program and when you look at this if it was our money and the states came to us and said we want you to pay all the medicaid costs for our citizens of the state we say yes and then we say we also implement the program through administrative costs and we want you to pay all of those two hundred percent i said well wait a second if i pay all the ministry of cause and i pay all the costs for the health care for your citizens what do you do in the state has no responsibility so this plan i would just as common sense that maybe i can convince you like the contents mr waxman last time to consider keeping the status quo you and i have lived it up here about twenty years and i together each and we've seen this program at fifty percent administrative costs why take it up one hundred percent in which the federal government loses control of it with no direction to the states to drive down costs and lastly the incentives for the state are such that they're just going to ask for more and more money you know i look at this strictly from the point of view of the uninsured and the people that are suffering because of the recession i'm not really that concerned about anybody but them and i would be fearful that whether it's florida which i guess has an increasing unemployment rate or new jersey unemployment rate isn't as bad but in both cases and in all the states they have large budget shortfalls and if we don't provide one hundred percent funding and you make them paid administrative or some kind of course sharing the likelihood is that they're just not going to cover these people and the people are going to be uninsured and all the problems that stem from that so i think which we're just trying to be realistic here and saying that we want to cover people who are uninsured we know the numbers are growing because of the recession and the best way to insure that is to make sure that that happens is to pay one hundred percent of the costs so that's why i would oppose the gentleman  also would urge opposition to this the states don't have the ability to pick up these additional costs that's why we have an f map program in the bill but for a two year period while we go through this deep recession we want the states to use the option to cover these unemployed uninsured people and we're not going to be able to create a whole new way to provide that care so we'd rather use the state's medicaid mechanism so we'll make these people eligible that's why we have one hundred funding it it wouldn't work without it this is only for two years let's let's do something to stimulate the economy by having health care provided for unemployed uninsured people opposition to the amendment all time has expired on the amendment all those in favor of the stearns amendment will say i oppose no no  nos have it the amendments not agreed to other further amendments you want to roll call you really want to roll you're going to  and we'd like to ask that amendment be distributed then offered by mr deal in subsection d d four of section one nine hundred two of the social security act as added by section three zero zero three eight two strikes that paragraph and insert the following a individuals without objection the memo be considered as read the gentleman from georgia mr deal's recognized for two minutes mr deal ok yes ok i was i was being told that it was drafted based on the original print rather than the committee substitute but i understand that that is acceptable and that would be a technical correction yeah if it went up ok thank you m chairman this is an amendment that deals with the section of the bill people being who are unemployed being able to buy into and become under medicaid now this does not require a ny asset or income test in order to be able to do it and the federal government under this legislation would be required to pay a hundred percent of the individual's calls to or in road under this program now i would hope that you would take the same approach with the millionaire men that we dealt with earlier as it related to cobra this is a millionaire amendment as it relates to medicaid and it simply says that if you have income of more than a million dollars that you would not be eligible to come under a government one hundred percent paid for federal government program providing you with medicaid coverage i find it somewhat ironic that the legislation does have built into it either an asset or an income test as a qualification requirement this would provide at least a partial cap own who would be considered eligible without objection such how would you go back general recognize himself in opposition to this amendment i want to emphasize to let me this right i want to emphasize that the economists and the nonpartisan experts from treasury have told us it is nearly impossible to guess what newly unemployed people's income will be the whole point of the temporary medicaid insurance coverage option is to build on an existing program that will get temporary assistance to uninsured individuals quickly so we want to streamline the the in roman process a million fifty thousand hundred  arbitrary amount but it's going to set up a nice unnecessary barrier if we have any income tax for medicaid coverage and i know it's going to be hard to justify this compared to what we agreed to before in cobra but i think when you talk about this medicaid you're talking about people who are lost their jobs are getting unemployment insurance they may be even getting food stamps their income and assets are going to be pretty low and i don't think we ought to put a barrier in the way of getting them covered right away on a two year program under medicaid by establishing something that would take probably years to figure out what the appropriate way ironic that the poorest of the poor are subjected to an assett income test to get on the medicaid rolls but under this exclusion we could have a millionaire who would not even be asked the question and would be able to get on the rolls with one hundred percent federal expenditure i just think that this is an oversight in the original real naming my time it's a theoretical issue you raise i think it's highly unlikely that you're going to find millionaires who would like to go on medicaid and we're talking about people who what well there may be some aberrations they're not going to be the upper income strata and we don't want to burden the whole system from moving forward for two years to cover them and let the states cover them without setting up a whole new and any members wish to respond to the vote that have not done so already and then there were thirteen eyes and twenty seven now thirteen eyes and twenty seven those are the members do not agree to either further amendments to this title if if not the vote comes on the amendment in the nature of a substitute as amended all those in favor if it was amended it was all those in favor of  measurement the nature of a substitute as amended will say i oppose no the ayes have it the motion now comes on reporting out the committee print as amended all those in favor  mr barton while the know mr terry on that so the i's were thirty two in the naser twelve thirty two i's twelve knows the motion is agreed to i ask unanimous consent that the staff be authorized to make technical and conforming corrections to this title and any previous titles that we've already adopted today our last title is committee print regarding the state medicaid fiscal relief without objection the committee print will be considered  purpose of amendment and without objection amendments drafted to the committee print regarding medicaid fiscal relief are made in order to this amendment the nature of a substitute this amendment contains a minor change of the text it has a section five thousand and seven that would temporarily raise the medicaid dish allotments for all states in fiscal years two thousand and nine and two thousand and ten by two point five percent each year majority minority staff have been provided with the today on the survey of forty states it finds that medicaid in roman is growing rapidly in some cases the surge is overwhelmed social service agencies in the states are being asked to meet this demand exactly at the time as a recession is driving down their revenues this is a draft will give the states additional assistance under they met with their medicaid costs for the period october one two thousand and eight through december thirty one two thousand and ten when hopefully will be through the worst of the recession under the text as amended all states will receive a four point nine percentage point increase in their federal matching rate or if matt states with high unemployment will get an additional increase designed to give the most help to the states with the largest increases in unemployment and no states regular matching rate can go down the texas amendment also included additional changes that will help state medicaid programs during this recession that would extend the current retore moratorium on medicaid regulations for the additional three months to give the obama administration enough time to dispose of them through notice and comment rule making if these regulations are allowed to go into effect state medicaid programs will lose two hundred million in federal medicaid funds in just three months and stamp states simply can't afford it it would extend existing medicaid work transition provisions until december thirty one twenty ten it would give states the option of covering family planning services for uninsured low income women who are not otherwise eligible for medicaid this is a curricle prevention initiative that actually saves both the state and federal government money by helping to be dusen number of unwanted births it would protect indian medicaid beneficiaries from car sharing when they receive care from an i h s or tribal hospital it would require both the centers for medicaid medicaid services and the state medicaid and chip agencies to consult with tribes when making policy decisions that affect them and finally the bill would temporarily raise the dish allotment for each state in fiscal year two thousand and nine and two thousand and ten by two point five percent in each of those years as c b l estimates the cost of these provisions eighty nine point five billion dollars over five years given the size of the medicaid crisis states are facing these seem like a modest response so the amendment in the nature of the substitute is before us and i will call on members who wish to offer amendments to this title  ther and then this chairman mr boyer chairman i have an amendment at the desk number forty seven chairman reserving a point of order gentle lady from colorado reserves a point of order this is the boyer amendment number forty seven did you say and i yes i meant without objection that amendment will be considered as read john is recognized for two minutes thank you my man adds value to the preventive health care mechanisms in the bill before us today by providing new pharmaceutical access protections for medicaid beneficiaries taking antidepressants and i psychotics and convalescence immunosuppressants anti cancer drugs and hiv aids drugs these are the six protected classes identified in medicare and heretofore referred to as the six protected classes of drugs back in two thousand and five when the committee worked on the deficit reduction act we adopted an amendment almost identical to this amend which i offer today all of my democrat colleagues on the committee and nine of my republican colleagues supported this amendment specifically under my amendment the state drug utilization review board must determine based on standards of practice and the strength of scientific evidence that limiting access to the six protected classes of drugs is not likely to harm patients or increase the overall medical costs these drug you'll as a sion review boards are to find under current law and and must have health care professionals who have recognized expertise in appropriate prescribe prescribing drug use review and evaluation quality assurance and other matters the boards must be composed of at least one third practicing physicians at least one third practicing pharmacists by a minute additionally ensures that medicaid patients have access to the medicines that they need if they do not hear back from the drug utilization boards within twenty four hours by providing patients with up to a thirty day supply of their needed medications currently medicare regulations specifically require prescription drug plans to provide access to quote all or substantially all end quote medicines for treatment of the six protected classes while medicare beneficiaries are protected we have no protection for medicaid beneficiaries so three years ago that's what i sought to do was to bring consistency between the two programs i think what we did was the right thing when we adopted this it when we in medicare part d my amendment works to ensure the same protections are afforded in medicare beneficiaries are given to medica beneficiaries currently there are virtually no federal protections for medicaid been fisheries on how states administer their prior authorization programs in contrast medicare regulations currently require all new drugs in the six protected classes to be reviewed by pharmacy and therapeutic committees these committees like the drug utilization review boards that i described earlier are required to be composed of practicing physicians and practicing pharmacists to incorporate the best philosophies when attorney whether to approve the drugs so to illustrate gentleman's time has expired you want to just conclude yes i will my minister chairman i've been told is really a no it's no cost score it does not prohibit prior authorization it merely requires medicare medicaid programs to examine the best science and medical literature in making these decisions i see continuity consistency and good patient health outcomes by bringing these two programs chairman i withdraw my reservation generally from colorado or draws or reservations chairman recognizes himself for two minutes i supported the gentleman when he offered this amendment i'm very sympathetic to what you're trying to accomplish my concern is that this may have a cost impact and we don't know what that cost impact would be if we adopted the amendment as a change in the medicaid program here in the pharmaceutical area and it also gets complicated because medicaid has a best price provision and i don't know how that impact that would impact that that particular provision so i'm going to oppose it now but i certainly want to work with the gentleman in the future to see how we can do to make this work i just don't think this legislation is the appropriate vehicle for such a change because of all these complicating factors yes i would like to work with the chairman it's been three years and it's been a lot of pain trying to see what's happening we have to see here treating patients differently what's hard for you for us here is that we don't get this we don't get the benefit of dynamic scoring so take mental judicial costs so i i would agree with the chairman there's a lot at stake here and what the chairman just mentioned is why i was not successful in a house senate negotiation three years ago and i want i want you to succeed all the way through on this provision because i for the me program for a normal rural hospitals and i want to emphasize to the committee three reasons why we believe these changes are so important for low income patients and why we believe this legislation should be included without objection gentlemen be given additional minutes mr chairman i'll be very brief and i thank mr rush for introducing this legislation to discounts to three forty b program are quite significant on an average it's about forty to fifty percent less than the average wholesale price over three forty b program is only for patient drugs as a result hospitals have to pay an average twenty five percent more for drugs given to patients made it to facilities stay overnight and only this result in higher pharmaceutical costs but then the hospitals have to maintain two pharmacies and two pharmacy inventories mr rush's legislation will not solve our health care was what goes a long way towards ensuring that safety net hospitals in this country can continue their mission of providing health care all patients regardless of their ability to pay is a good commonsense cost saving measure and mr rush if you yield to me i want to express to you my strong willingness to work with you mr stupak on this issue it i think the high price of drugs is an important issue for this committee committee's consideration and just the example of what we've done for those who have been medically on medicaid and switch over to medicare i think is costing us a couple billion dollars a year same drug same people just a couple billion dollars board costs and if we could get the lower price to some of these institutions it would mean a lot of savings amendment without objection the amendments withdrawn are there further amendments to this title mr chairman who's seeking recognition of mr pitt i have an amendment at the desk of m and zero four five chairman reserv point of order later from colorado reserves a point of order the clerk will report the amendment and the amendment be distributed offered by mr pitts entitled five at the end of the section nineteen to nine hundred twenty c of the social security act added by section five zero zero four be the following the parental notification chairman i really don't understand what the expansion of family planning services has to do with stimulating the economy but my memory has to do with parental notification in this section tomorrow for minors subsection a stablish is criteria for individuals who are eligible to be beneficiaries of the new state option established in section five zero zero four the criteria includes a new loophole to permit sharp tisha syndrome of minors or virtually any family income level in this program without the knowledge of the parents or consent of the parents instead of helping loving parents protect nurture raise their children this bill is currently drafted would keep parents in the dark it is unconscionable that clinics leave parents in the dark while their children receive medication that made be detrimental to their health or even deadly parents know their children's medical history parents are best able to make medical decisions for their minor daughters and parents should be informed when their child is given prescription medication medicine i'll just cite one example of molest a teenage girl who had a terrible reaction to a contraceptive drug after she received it without her parents knowledge and when they found her vomiting and screaming for help her parents had no idea that she would she could be reacting from this drug she was rushed to the emergency room where she was treated for reaction to this drug there's a reason why school nurses have to get permission before administering tylenol to kids and why parents have to consent for  tattoos parents know their kids best and their best equipped to help them make good decisions and when parents are knowledgeable about their children's health care they can protect their daughters from sexual abuse and predators nearly all children and teenagers will qualify for this program under the current language as this bill expands family planning coverage to minors the least we can do is make sure their parents are notified my member would ensure that parents are informed and able to be a part of their i seek time in opposition to the amendment we only have two minutes and i know miss capps wishes to speak on it as well so i hope in the course of managing the two minutes in opposition you would yield to her absolutely mr chairman the ladies recognize for two minutes chairman i just point out a couple of things number one there's no current requirement under medicaid for parental notification for contraception number two this is contraception not abortion and i will remind my colleagues on both sides the aisle once again if we want to prevent abortion we should have contraception while most adolescents will consult with their families about contraception unfortunately this does not always happen and i will finally point out mr chairman that while a number of states require parental no notification in some circumstances for contraception there is not one state in this country and again and not under medicaid to states require parental notification for all adolescents to receive contraception this is just incredibly broad and it will be detrimental to the health of the young women of america with that i will yield to mr capps i thank my colleague for yielding mr chairman i believe it's essential to retain the underlying language w is a state option for covering family climbing planning services my state of california has received this waiver for a long time and has tremendously positive results for the patients who benefit every year california's family planning program serves million and a half clients and state saves the state two billion dollars in answer to mr pitts question how does this save the economy for every dollar spent on this program california save two dollars and seventy six cents in medical and social services costs within two years in two thousand and seven see below estimated savings of two hundred million dollars over five years and four hundred million dollars over ten years for a state option to cover medicaid family planning services for all women who would be eligible for pregnancy related care and not only saves money it's a good health care practice so i urge my colleagues to support retaining the language to oppose this amendment and to make coverage a family planning services a state option and return  mr rush no mr barrow sparrow votes no mr hill to hill no there are no other members who wish to respond to the vote the  i have an amendment at the desk a clerk will report the amendment and have a distributed amendment to the committee print offered by mr dio at the end of title firemen hollowing reserve the reserve a point of order general a from colorado reserves a point of order without objection the amendment will be considered as read and the gentleman from georgia mr deal is recognized for two minutes thank you mr chairman as many of you recall i raised the issue of pricing transparency on health care during which were not proceedings we had this past fall i think that the  the issue of knowing what you're paying and what it's going to cost you one i don't know should i mean in health care as it does in most everything else if you're going to buy something a good or service you generally know in advance how much it's going to cost that is not true when it comes to health care some of you will recall the illustration i used of a young man who works here on the hill who last year had to have an emergency appendectomy there was confusion as to whether or not he had insurance coverage and several weeks after he got home he received a bill in the mail for nineteen thousand dollars for a one night stay finally when it was clarified that he did have insurance it was settled by the insurance company paying twenty one hundred dollars with that kind of differential is it any wonder that the number one cause of personal bankruptcy in this country is the fact of medical bills that people simply cannot pay what this bill what this amendment does is simply require hospitals that are receiving payments from medicaid to publicly disclose the prices charged for the services to the uninsured and to self paying patients i think patients ought to have a right to know what they're going to be charged in advance mr chairman i would like to respond in opposition i know mr deal has raised the issue of transparency and particularly with hospital charge sheets and in other situations and i'm sympathetic to that but i just don't think that this is the time to do it i mean we really don't know whether this information is useful it may just make it more difficult i think to move ahead with the legislation i i have said him that you know we certainly intend to have hearings in the subcommittee to address these transparency issues and and it's certainly something that could be and in the context of health care reform and the hearings that we would have on health care reform but i think that right now it only serves to increase  you know possibly the burden on hospitals and it needs to have a hearing and have a more of an opportunity to see in what context we should do this i don't think the information is necessarily going to be helpful to individuals right now without  further investigation of the whole issue of transparency in this concept context so i would urge the opposition to the amendment not because we disagree that these types of things need to be done but i just don't think that this is the time to do it without further hearings and and further investigation of the general and you certainly could you give me some indication as to when we might expect those hearings well we're going to have a searing series of hearings on the whole healthcare reform issue and we can certainly this in the context but you know i know we're we've been busy with the stimulus right now so i don't have a time period but i think it can be taken up in the context of health care reform gentleman yield to me well i think you're absolutely right when we do health care reform we should look at what kinds of information will best enable consumers to make informed choices about their care but i don't think the legislation we're debating today is the right place for this kind of an endeavor but i would join you in pledging to mr chairman i was just simply going to enquire from the minority standpoint if we could have some sort of timeline as to when to expect these hearings on health care reform because many of the things you just just today are well will fit into that venue and i think it's it's fair to keep us apprised as to what plans we certainly will we certainly will keep everybody apprised of the schedule in the plans and and i want to discuss all these issues all time has expired on this amendment  colorado withdraws your reservation on the point of order all those who favor the deal amendment will say i those opposed will say no no those have it the amendments not agreed to ask for a co without objection the amendment will be considered as read will be distributed here and the gentleman from georgia will be recognized but before he is recognized the gentle lady from colorado wishes to reserve a point of order thank you gentleman from georgia mr d committee in the past you have heard from your community pharmacist on this issue for those of you who are new to the committee i assure you you will hear from your community pharmacist on the issues embodied in this amendment this is an issue that i raised  last year and when i offered this amendment in last year ours persuaded by the democrat majority to withdraw it on the condition that we would have a hearing and a bipartisan conference with pharmacists and other stakeholders in the pharmaceutical delivery industry i am still waiting for that conference to be scheduled and as you know it is not happen now there are three components to this particular amendment and i would hope you would listen to them one of them is that it deals with a provision that was put into regulations and it was contrary to the intentions of this committee and we've been unable to correct it and that is in reimbursing the brick and mortar pharmacies that is your community pharmacist by removing the sales to mail from mail order pharmacy is from the calculation of the federal upper limit  for generic drugs and this amendment would separate that out and would also set a separate category for calculating the federal upper limit for mail order pharmac secondly it would give the states the increased flexibility to reimburse pharmacists by increasing the federal upper limit on generic drugs from two hundred fifty percent the lowest average manufacturing price amp to three hundred percent of the volume weighted average of all amp prices which if any of you have familiarity with pharmacies you know this is the fairer way to reimburse your pharmacist and it also includes a provision that says that states cannot get this bonus money under medicaid unless they require unless they are providing at least a dispensing of nine dollars per prescription for the multi source of prescription drugs generics and their medicaid program this committee passed out a provision that required a minimum of eight dollars dispensing the as a part of the deficit reduction act but it was unfortunately not agreed to by the senate these are three provisions as it relates primarily to your community pharmacist and i would urge you to pay attention to this one i think it's important for all of us effect it has on access to prescription drugs but this amendment creates several problems and that's why i can't support its inclusion in the legislation it says unless the state is able to  pass legislation quickly to establish a nine dollar dispensing fee the state wouldn't be able to get a temporary medicaid assistance program secondly the enactment of this amendment would increase state's medicaid costs and this could adversely affect states in forced cuts and other services during a time of fiscal distress and it's unclear that requiring the same this fence dispensing fee level in every state makes sense given and i appreciate and i think the intent of the gentleman and i think you're going to see many of us raising the subject of the challenge is community pharmacies make they are they are the ones that are getting squeezed in the vice that they have no way to get out of i think everyone has some way to pass along costs and this i agree with you this isn't probably the vehicle and maybe this isn't the perfect the perfect amendment but i think that perhaps this is chairman if you would take it under advisement how many of us are concerned about the plight of kony pharmacies how many amendments that are coming a covert a trance and in this bill that maybe at some point chairman for allowing yourself what we can try to come up with a strategy to help them because they really are in desperate straits i think the gentleman makes an excellent point and i certainly will want to work with you and urge that german fellow and hold hearings on this question and see if we can miss to get miss to get now mrs capps mrs capps now mr doyle ms harman is harman no mr stearns mr deal i should deal i mr wade field and the other members wish to be recorded not the clerk will tell you the vote mr chairman the essence of being an american is choice we all enjoy the choice of being able to pick what kind of car we buy what kind of shoes we buy all of the thousands of choices whether we buy a name brand aspirin or a generic aspirin all those types of decisions everyone in this room at least sitting at this diet gets to make choices about their health care the essence of my m m it is simply to say that americans on medicaid should have some level of choice we all enjoy some degree of control in our own lives and i think it's important to give people on medicaid some degree of control in their own lives in the base legislation we're going to add nearly one hundred billion edition dollars to medicaid there are people currently receiving medicaid benefits who are eligible for employer sponsored group health care but can't afford to pay for it and i believe we should give them choice i think we should say to them that you have the ability to make two choices in many of the great programs that this government is  i would cite for example the food stamp program we do not say to american citizens who need help financially in buying the groceries they need here are the foodstuffs you get these specific foodstuffs and nothing else we don't require them to go to a government cafeteria instead we provide them with a voucher and we say to them take this and go buy the food you want in the medicaid program there are many critics of it and many proponents of it but there are people in this country who could if given the possibility purchase a program through additional financial assistance of their choice and i think that a given that choice earlier you said mr chairman in discussing a similar issue that there might be coverage they might buy coverage less than they would get under current medicaid programs if you will notice in the language are written we've said that this would allow them to exercise that choice but only to purchase a policy that benefits equal to and coverage equal to or better than the medicaid benefits offered by their state in the discussions that matter  said that he was concerned about the difficulties of states in offering this option to people who get medicaid benefits my concern is what mr blown said later and that is he felt that under programs of this nature our number one concern ought to be the recipient of the benefit i don't really care if it's a little bit more difficult for states to say you can get medicaid or you can keep your employer sponsored care and we'll pay a little bit toward the difference i think the focus ought to be on choice and i think it ought to be doing the context you know states have the option of doing these premium assistance programs now if they think that they're beneficial in that they think that they can get you know people that are medicaid eligible to you know to find that option but oftentimes the option doesn't exist because you know the individual market is very difficult and i just don't want to put a straitjacket on the states that they have to set this up as a condition to get their f map benefit because it's going to it could theoretically slow the process down and we're just looking for a quick way to get health coverage for those who are uninsured so again the flexibility is there if the states want to do it but if they decide that it's not a good way to operate given that we're trying to have a quick fix here to g people covered i don't think we should force in the do it and require it so i would oppose the amendment gentleman yield in other words you will allow the states to have a choice and if states don't want to do this they don't have to and this amendment by mr says the states have no choice they have to do it his way or they can't get any money under estimate exactly what the gentleman yield sure i guess i understand that it might impose an additional burden on the state yet in a different context you said in response to a comment by mr deal that the number one concern ought to be with the recipient of the benefit not with the design of the program the number one well earned if i could take back my time my number one concern as i said before is that we get people who are uninsured insured and so i say that in the context of the easiest way to get as many people insured as possible and if the state feels that this is going to be a roadblock then then i don't want to put that roadblock on the way because then that would make it more difficult for people to get insured so it's a different context the way you're saying i think it's going to get as many people insured as possible if the states feel that this is a good way to do that fine but if they don't and they think it's and all those of ten opposed to the member please raise your hand mr murphy from connecticut thank you mr chairman i don't have an amendment i just want to engage with the chairman in a short colloquy on the underlying substitute language gentleman is recognized mr chairman i like to thank you in the drafters of this bill for including language that protects beneficiaries of medicaid programs by requiring states that accept this f map increase to maintain their levels of eligibility with regard to their medicaid  program i think that's incredibly important because as we know the first place that states go when they're looking for savings on one face of budget shortfalls also is often that medicaid line item the bill specifically gives them the latitude to  change the benefit packages but it's largely silent on the issue of rates and i just have a fear that though the states will be constrained on the issue of eligibility that they may use the latitude to decrease rates to the point of effectively throwing people off of the medicaid rolls because they don't have access to providers the existing statute has a requirement to say that rates have to be sufficient is quoting from the statute to enlist enough providers so th and services are available under the plan at least to the extent that such care and services are available to the general population and my question as chairman is just that this committee is intent that states are still bound by that requirement and that we're going to  ask and expect the new administration through h h s and c m s to hold states to that standard in the underlying law regarding rates if the general we appreciate your bringing this issue to our attention it is the intent of this committee that states receiving increased f map payment must comply with the letter and spirit of existing law in maintaining provider payment levels in addition the committee will carefully watch states reactions to this legislation will try to ensure that states do not use this increased federal match to constrict provider payment levels below the requirements of current law i think the chairman very much for his attention to this issue and for that response and i'd also ask th the committee maybe look into some further oversight on this issue so as states go through their budget process sees this spring and summer that we make sure that they aren't going against as you said both the spirit and intent of the underlying law on r service drug rebate to drugs prescribed under medicaid managed care worked at the state safety net providers health plans and patient advocates to ensure that this language protects health plan and rowley's generates savings to the federal and state governments and protects government programs from this amendment reflects common sense policy that the congressional budget office said would save the federal government levon billion dollars over ten years furthermore the amendment provides immediate critical fiscal relief to states at the time in this economic downturn these are savings that could be used for could be used to prevent tax increases or cuts in benefits or services and education health care transportation and medicaid drug rebate ensures that state run medicaid programs receive the best price for prescription drugs for their medicaid beneficiaries despite my belief that this memo will provide significant fiscal relief to our struggling states and that enjoys widespread support i will withdraw my amendment i want to be clear about why i'm withdrawing this amendment it's not because i don't believe this bill can stand on its own but quite frankly mr chairman i'm very concerned by what i see as disproportionate influence by pharma the drug manufacturers how is it we all you seem to make cuts to hospitals doctors and world providers but never ask the drug manufacturers to bear their share of the burden this chairman is why sincere hope that this concern over the drug manufacturers bottom line is not going to set the mood f deliberations or next two years and with your assurances mr chairman i look forward to working with you in the coming months to address the concerns that you have regarding this legislation it's my hope that we find agreement on this legislation in order to move this important of us and many other members of the committee without objection the gentleman withdraws the amendment now you mr chairman mr gately you have an amendment mr chairman i have an amendment to the desk on behalf of m recognized for two minutes to speak in favor of the amendment mr chairman thank you we have heard it mentioned a number of times tonight objection to certain amendments over concern about slowing the process down i certainly hope that this fairly simple but important amendment the majority would agree that this was one that is worth slow in the process down over it simply ensures that all applicants for the medicaid program document their identity to ensure the state to actually implementing this important and defraud provision this amendment prohibits the secretary from distributing any funds under section five zero zero on the temporary increase of medicaid after map to any state the secretary finds is not in clients would this it in if you verification requirement was chairman in order to encourage states to come back into compliance with this provision non compliant states would be given thirty days notice before any funds are with and the states will be allowed to receive section five zero one funds again as soon as they are found to be in compliance with this provision this is no small problem and i think my colleagues would agree with me a number of states i could name states  much as ten percent of medicaid spending is simply criminally fraudulent and other states three percent or more than rowley's in the medicaid program were determined to be illegal aliens or other non qualified aliens quite honestly let's slow down and make sure the verification of medicaid eligibility is as they are in this emergency medicaid program aftermath expansion that in barriers in the way of a program that we're trying to address quickly we know that a lot of people are becoming unemployed the unemployment rates continue people lose their health coverage as a consequence and if you start to put these identity barriers in the way it's going to be more difficult for them and more difficult for states to access the money so that they can provide the coverage in my understanding is that identity is even more difficult to prove than citizenship and we have an example in one state in wisconsin the one state that tracked data nineteen thousand four hundred thirteen people were denied coverage or less coverage in a seven month period because they failed to meet the citizenship documentation requirements these two thirds actually provided proof of citizenship but not identity so i mean at a time when we're really worried about people losing their coverage and the whole purpose of this is to try to quickly get them georgia people would say it be cruel and unusual not to done a fine and i would hope the people in new jersey would feel the same way and it's literally in this rush to if i could reclaim it's often difficult for people  to you know prove their identity and then the other thing what i don't understand is that if if if you use someone else's identity then you're going to change treatment under that person's name and and health history i mean it seems like who would even want to seven month period because they failed to meet the citizenship documentation requirement and of these two thirds actually provided proof of citizenship but not identity and i think that time has expired but i any member wish to respond to the vote roll call that has not yet response or mr ross votes by any further votes the clerk order gentlemen from georgia mr deal has an amendment at the desk a gentle lady from colorado reserves a point of order and them it will be considered as read and the gentleman is recognized for two minutes  chairman this relates to an issue that we have dealt with just recently and that is under the s chip bill under current law if an individual is allowed and permitted to come into this country as an immigrant it has been the requirement that they agree as a condition that first of all they will have a sponsor and secondly that that sponsor will be responsible for the forty five year period and that they will not immediately go on to our welfare or social service roads this bill removes that five year requirement now i know that you're going to say well we voted to do that last week in the s chip bill and it is true that it was done in the s chip bill but i would remind you that last week the s chip bill came to the floor of the house without coming through any committee without any opportunity to amend it in a committee and came to the floor with a closed room with no opportunity to amend it on the floor and therefore if you voted for the s chip expansion and this was a part i'm sure you might be able to say to you constituents who ask you why is it that you now want the american taxpayer in a time of recession to take on responsibility for people who said they wouldn't go on our welfare rolls for five years and now you want to put them on there well that was just a part of a larger s chip bill i'm going to give you the opportunity to vote on this  a free standing issue with their samin and make it clear to your constituents whether you do or don't agree that people who are allowed to come into this country should not be allowed to immediately go into the medicaid ro and if you do agree that they should not be allowed to go immediately and should be required to be self sufficient or to beas can covered by their sponsor then i would hope that you would vote for the amendments chairman ike i withdraw my reservation let me say just say mr chairman i will say what mr dale said i was going to say which is that we just voted on this in the in the s chip bill and the reason that we did is because it makes sense i mean people are here legally we're only talking about legal immigrants now under all different circumstances some have sponsors some don't you know they can be here in a variety of situations but the bottom line is it doesn't make sense to have them to have to wait five years to have coverage and what does that mean that they don't have coverage they delayed care they end up in going to the emergency room which costs even more money sometimes ten a hundred times that of course for them to be able to go to a doctor it doesn't really make sense to say that if someone's here legally that they should not be provided coverage because it's just in the long we're going to cost us more money so i i would ask that we oppose this i would yield to the gentleman from texas thank you mr chairman and i thank god chair of our subcommittee mr blown said that these folks just don't come into the country and you don't get on s chip for their children or medicaid these are folks who are laid off and have the option to  take this if the state allows it and again like mr billow said the children would die in families would be waiting in the waiting room and it emerged because they lost their insurance because of their employment and again it's a state option and that's why vote on the bill gentlemen go ahead jim you go ahead i was asking for time or did i chairman i just want to point out it's especially ludicrous to talk about a five year solution when you talk about children because of children had to wait for five years then they wouldn't get the treatment they needed thank you same applies to a pregnant woman five year wait for a pregnant woman makes no sense at all it's stupid and it's morally wrong gentleman's time has expired the vote now comes and that mr chairman the i's were eleven and the names were thirty one eleven thirty one no the amendment is not agreed to further amendments at the issues that they would have raised and i'll be very brief one is that we have in the past appropriated a permanent annual funding for investigating for already in the medicaid system of twenty five million dollars that is now stripped out of that bill after one year i personally believe that we need to with all the bad stories we've heard in the past about fraud in the medicaid system we need a permanent fraud funding source that the states can count on and i would ask the chairman if he would take a look at that the other amendment would have increased or sped up the process of electronic verification of assets by two years we currently have the law that says it will be in place by two thousand and thirteen this would have reduced that down to two thousand and eleven it would save billions of dollars if we have that in place under c b o scoring your state under stand is going to have that in place by the end of the fiscal year and be able to do that i would ask you if you would consider those two issues and if you have a manager's amendment if they have merit i would ask you to include them gentlemen we'll die certainly we'll look at those issues and want to work with you on them like you need to do all we can previous title and i would ask unanimous consent that the blunt amendment number one as a as amended be agreed to and inserted in the appropriate place in title for mr  blunt i think the chairman for taking time to work through this i just want to express appreciation misses you and miss to get for believing that we could work this out and to you mr markey and mr blown for being willing to take the time to work it out certainly mr winter and mr ross who understands these pharmacy issues better than any of us were helpful in working with the staff and the staff worked hard to find a language out of other regulations that they think clarif this amendment in the way it was intended and i thank the chairman for the time we were able to take to get this done and hope to see it included mr blunt recently will press for this cement this compromise there are other parties that have to agree to it because other committees have jurisdiction but i think it's a good compromise and we'll certainly do all we can to see it included in the bill without objection that unanimous consent request is agreed to the vote now comes on this title the amendment in the nature of a substitute as amended all those in favor of the amendment in the nature of a substitute as amended will say i i know the eyes have it in them it's agreed to martin requested a roll call vote on final passage of this title one well gentlemen to request it let's go through another roll call vote this will be this will be the last roll call vote that will have this evening in it before members scamper out of here i want to extend my gratitude to everybody who's stayed in what has been a twelve hour since our committee first was convened by both the aisle that patience and tenacity of all of you to work this through very much  appreciated and important for all of us especially also want to thank the republicans for working with us to expedite the process process of this bill by agreeing to the time limits in consideration of amendments we will now conclude this last title by a roll call vote all those in favor of reporting the title out as amended will say i those opposed will say no to i would now call up h r six to nine without objection the text of h r six to nine will be struck after section one and replaced with the text of the five committee prints the committee approved as amended at today's business meeting and the committee will order reported to the house h r six to no any objection without objection that will be the order the chair will also call forward h r as thirty one sponsored by mr price from north carolina this measure expressed support for the designation of january twenty eighth two thousand and nine as national privacy day and i'd the minority has the usual two business days to prepare minority views on the bills have just been reported without objection that will be the order thank you mr jack concludes our business we stand