eighteen who are in juvenile detention facilities which would say states that during the time that they are in those facilities there if they were medicaid eligible when they went in that eligibility would be suspended and they would be put back on medicaid when they come out for the millions of the hundreds of thousands of children in this country who are incarcerated many of them have pretty severe physical and mental health issues and the last thing you want to happen when they get out of incarceration and go back to a foster home is to have their medicaid eligibility cut off and for them to go off of therapy or medications so this is a simple amendment which just has you suspend that medicaid eligibility reinstate them when they come out of the facility and then do an evaluation  their circumstances have changed then you can take them off the medicaid rolls but at least make sure that they have that transitional moment as they had out of institution and back into the community and with that glad to  our public institutions of any sort are not eligible to services while they're in that institution they may retain their eligibility for services outside the institution but they are not eligible to receive services th during the period of time but our incarcerated and a juvenile court judge for example calls a hearing and as a result of that hearing he determines that the youth is to be immediately released from the juvenile detention facility and for some reason the state has not brought his registration and eligibility for medicaid up to date while we going to be holding these young people under the provisions of this act which says that they shall not release them until they have them registered but yawn the period of time that the judge has ordered that they be  incarcerated congressman as i read the bottom of page two they retain their eligibility they retain their role unless and until there is a determination that the individual is no longer eligible eligible to be so and r l and then goes on to says that it should be completed before such states of the use can access so under the terms of this amendment they state is supposed to do an eligibility determination of eligibility before they are discharged and if there is no reason to find that they are no longer eligible they're supposed to keep their eligibility running when they are discharged if that gentleman reading that interpretation is c medicaid benefits when the when the child goes into the facility and then makes them go through the reallocation process once they get out simply says as a default let's make sure there's no gap but let's correct unless they are suppose it's possible for somebody to be under the age of eighteen and yet at the same time be independent but for the most part it's on the basis of the family's income and so we are a detention facility i'm just concerned that we're creating a huge nightmare for overcrowded institutions that are looking for opportunities to get approval from a court to release this individual and we if they think that the child has changed and if i may under current medicaid law states are required to do periodic redetermination of eligibility at least once a year and many states  affect medical liability in the practice of medicine and it was that amendment was ruled not germane and the chairman graciously allowed us an opportunity to rework the amendment to  achieve and that is what this amendment represents the principle difference between this amendment the amendment that was originally offered is that the protections provided each of the sub subsections shall apply in the case of a health care provider with issues that were brought up two weeks ago on the first offering of this amendment many or force to practice defensive medicine which results in millions of dollars of unnecessary tests and procedures season medical professionals are retiring early because staying in practice is no longer financially feasible for contributing to our physician manpower shortage that nationally across the board changing the medical justice system would lower costs and improve care by lessening the threat of lawsuits and unmerited lawsuits they often bring about and specifically cap noneconomic damages two hundred fifty thousand dollars for the physician two hundred fifty thousand dollars for the hospital two hundred fifty thousand dollars for a nursing home or a second hospital if a second hospital was involved the cap on wrongful death awards one point four million expert opinions relating to physicians may only be provided by actively practicing physicians payment of future damages on a periodic or accrual basis limitations on liability for good samaritans providing emergency health care mr chairman this is patterned after legislation that was adopted in my home state of texas as it has increased charity care rendered by texas hospitals which rose twenty four percent following the enactment of this legislation texas has licensed over fourteen thousand nearly fifteen thousand new positions in the first five years after and acting this legislation thirty three rural counties have seen a net gain of e r doctors including twenty six counties that previously did not have an emergency room physician for this amendment will tell america's physicians that we are committed to putting in place reforms that will allow them to do their job free of government a special interest intervention vote for this american amendment will tell america's patients that access to high quality affordable health care is indeed our goal and i thank the chairman first consideration allowing us to rework the amendment and re offer it and with that i will yield back the balance of my time thank you with any other member like to be heard on this amendment mister gentleman from i thank you i strongly oppose this amendment we all know the most significant way to reduce the cost of medical malpractise is to emphasize patient safety by reducing the number of preventable error medical errors according to the institute of medicine and its seminal report preventing medication errors if other report to err is human building a safer health system and its other report patient saving achieving a new standard of care americans should be able to count on receiving health care that is to achieve this new health care delivery system is needed a system that both prevents errors and learns from them when they occur this requires first a commitment by all stakeholders to a culture of safety and second needed improved information systems according to the institutes of medicine every year preventable medical errors kill as many as ninety eight thousand americans the center for disease control if it included preventable medical errors would be the six leading cause of death in america the number of americans injured each year by preventable american medical errors is much larger the institute for health care improvement estimates that fifteen million incidents of medical harm occur each year according to the institutes of medicine every day tens if not hundreds thousands of errors occur in the u s healthcare system to address this problem the institutes of medicine concluded patient safety is indistinguishable from the delivery of quality care and it recommended that a new delivery system must be built to achieve substantial improvement in patient safety drug errors are the most common error of all the institute of medicine estimates that on average every hospital patient in america is subject to one medication error each day they're in the hospital these are called adverse drug events and the institute of medicine estimates that each year at least one point five million preventable adverse drug events occur in u s hospitals that add nearly five thousand dollars to the cost of each admission the defensive medicine claim that is constantly being made by my friends on the other side has been researched thoroughly by the g a o and the institutes of medicine they have questioned the validity of the defensive medicine claims noted in its two thousand and eight report that the evidence on defensive medicine is not conclusive and whether limits on malpractise torts have an impact on the practice of medicine has been subject to some debate g a o issued a similar statement in its report earlier this decade noting the overall prevalence and cost of defensive medicine have not been reliably measured researchers from the dartmouth atlas project similar conclusions this year noting that fear of malpractise suits is reported by many physicians to influence their practice but differences in the mouth practice environment explain only ten percent of state variation in spending one of the other things that's often claimed is that the number of physicians is declining because of this problem when reality using the a m a s own physician characteristic in distributed distribution data these conclusions are undisputed one the number of doctors is increasing  has been increasing every year in the past decade the number of doctors is increasing faster than population growth the number has climbed steadily for decades and is twice the number of doctors per one hundred thousand in the  number of doctors is increasing in every state the ratio of doctors to population is higher in states without caps on damages and medical negligence and states that have caps on damages the number of doctors per one hundred thousand population is three hundred nineteen while states with caps on damages have a lower ratio of two hundred eighty three another known fact is that insurance premiums are related to market conditions and not  claim to benefit from tort reform how do we know this well mr burgess has cited the tort reform efforts in texas after that tort reform legislation was passed in two thousand and three the dallas morning news did an investigation and found that while hospitals and medical malpractise insurance carriers made millions of dollars over the next few years no hospital or doctor cut the prices they charge patients or health insurers to reflect any savings from tort reform and finally the national practitioner databank which collects statistics on medical errors and settlements has shown that there has been a steady decline in the number of payouts between two thousand and two and two thousand and six from the number in two thousand and two which is fourteen thousand and three ninety one to two thousand and six when those payouts were down to eleven thousand seven fifty nine mr chairman this is a problem that has much effort being devoted to it but it is a problem that is not in need a solution we need a safer patient safety system and that's what we should be focusing on gentleman's time has expired mr chairman burgess recognize study in the ten years since that one was released and we're relying on data that was collected in nineteen eighty four i would submit to you the practice of medicine has changed significantly since nine hundred eighty four and if you don't believe if you believe the health care facilities  your district and get to know them i would further submit that if you think that medical liability for your physicians in your district to have a visit with your county medical society and get their take on this i know that this bill before us has been endorsed by the american medical association but i would submit to you that doctors across this country want us to fix this problem they are tired of waiting and they should make their voices heard to members on this committe is the doctors won't show and care last weekend i spoke with a doctor and doctor and he explained to me that in their emergency room they could not get many specialists they could not get hand surgery specialist they could not get in some instances  care mr gonzales thanks very much mr chairman first of all let's get straight what we're talking about we're talking about meritorious lawsuit where there is negligence you're talking about capping damages we're not talking about trying to stem some imaginary  prices of frivolous lawsuits we're talking about defensive medicine we can talk about that and so what are these great savings that we're going to realize if we impose these kinds of restrictions on the right of people to seek redress from negligen all of that would be i guess an outcome but let me two thousand and three goes into effect from two thousand to two thousand and seven texas health care insurance increased eighty six point eight percent the average health insurance policy went from six thousand six hundred thirty eight dollars to twelve thousand four hundred and three dollars now because of these tremendous savings that texas has been able to realize because of this incredible law farsighted law let me give you the texas experience and this is what the other states as far to go four point two million texans do not have insurance thirty percent of our population one point five million children twenty one percent don't have coverage of any type now that's what this law has produced go ahead and replicate in all fifty states it's a great experiment that did not work but go ahead the real sad thing about this law is that it's the responsibility and the liability from the negligent party to innocent party not just the victim but all of those that will have to incur the cost to care for that victim to truly compensate that victim for that injury that's the injustice of these laws that the negligent culpable party is set free without truly paying for the negligent acts now since when do you want to reward people and not whole him accountable to  liability in the exposure to liability is what instills accountability so i would ask members of this committee look at the texas experience and reject it i think the gentleman you know  chairman i have before you what i think to be a very simple amendment to fix a small problem that affects about a thousand beneficiaries i'm told it may be six hundred beneficiaries under current law medicare beneficiaries take ownership of their therapy beds after medicare is thirteen months capped rental period these beds are very complicated very complex highly emotive and highly effective that is a piece of durable medical equipment you paid enough in rental that you paid for the bed that we stop making payments in the in the individual using the ownership which over time saves money is that the gentleman's intention say there's no monetary issue here at all as i understand it and as have i've been told that the beneficiaries sometimes who are very disabled are stuck with a thousand pound bed in the house and they don't know how to get rid of it and sell the motion to recommit and to vote for final passage so we'll take a could we handle one more thing dr murphy has an amendment it shouldn't take that long mr murphy you have an amendment that you think will not take too long i can  read recognize mr murphy thank you mr chairman as we look at ways to save money and actually provide the best care study that came out of the new zealand healthcare institute noted that some six hundred billion dollars in costs in health care can be accounted for by some variation in medical treatments that are sometimes regional it says that many of the interventions vary dramatically among regions with no real explanation for the variations they found particular evidence of rates of many specifical surgical procedures that vary month geographic areas including coronary artery bypass grafting percutaneous coronary artery and your plastic surgery hip replacement disseminated to position itself we know that nothing here prevents anything that may be a breakthrough in science or store surgery or medicine from being used but is saying that those some things that would be taken into account as procedures are looked at  recommend the gentleman you know what this amendment would require the center on comparative effectiveness research to consult with the specialty colleges and academic academies of medicine i think this is a sensible idea i do have concerns about some of the all those in favor the members say i oppose no the ayes have it and the amendments agreed to we will now recess to respond to the votes that are coming on the house floor after the votes on the floor  requested members return so that we can further consider this legislation misrepresentations improper use of personal information aggressive sales practices across telling when they go in to sell a medicare part of the plan and sign up the senior for a medicare advantage plan but they were not interested in  talking with seniors one on one personally that have been subjected to these abusive marketing practices i've been called by the directors of senior centers that have had to deal with agents coming on site uninvited to solicit folks that live in the senior center but worst of all many many seniors with dementia and alzheimer's disease have been targeted by the sales practices largely there have been huge commission involved now the congress did act and gave c m s some additional authority and c m s is trying to pick up their oversight but they just haven't been able to do the job and it's very important that we return this authority to the state to investigate the consumer complaints provide oversight and ultimately hold them accountable this amendment has strong support by the national so ca sion of state insurance commissioners and in their letter of support have written the centers for medicaid and medicaid services has made greater efforts to improve oversight in recent months in either it has neither the staff the expertise nor the experience in regulation plan marketing to effectively protect seniors the states on the other hand have experience and relationship with plans to correct problems quickly and to prevent these problems from reoccurring their states are closer to what's happening on the ground  engage counsel on a question i think we understand what the goal is here of trying to standards with regard to people who are conducting activities that may be considered somewhat fraudulent as i read this amendment it appears that we are delegating up already to the national insurance commissioner organization to come up with  more concern than the second one because i think it would be within the secretary's parag to promulgate regulations it appears though that the language you just quoted might say that whatever the standards that are developed by this outside entity the insurance commissioners organization that the secretary shall promote from all get regulations for the adoption requirements my concern is a legal concern  is going to be considered an on a lawful delegation legislative authority to a non elected outside entity to give them sole discretion in terms of promot  incorporate many provisions that are much less specific than this secondly since it does not delegate to the and the authority to issue regulations secretary to issue regulations she could review these recommendations and adopt regulations that she in her discretion believe incorporates such requirements and since the courts have routinely recommend recognize that  interpret ambiguous legislation the secretary under chevron deference is given deference i have no concern that this is either over delegation of authority or strapping the secretary down what are the one of the penalties for violating these standards where are they is to deal do not see specific penalties in this provision i would assume to the secretary either as he could be either as she promulgated regulations incorporate specific penalties or she could consider that a failure to meet these standards would result in an inability for these plans to participate in the medicare program so we don't know whether there could be monetary penalties civil sobel monetary penalties or whether the penalty would be that if you don't meet the requirements you just cannot participate in a medicare program as i read it in my reading of this language that delegated to the secretary the secretary could be in the context of something we're adopting rather than having to guess at it the medicare of course long and complex but in many cases believe that it  delegated to the secretary to decide on the most appropriate enforcement gentleman yield back any further discussion gentleman from wisconsin thank you mr chairman i move to strike the last larger bill that the current configuration of medicare advantage plans make it impossible for beneficiaries to make fully informed decisions about which policies to buy and i think that transparent and standardized marketing will help beneficiaries in that regard to a great extent and i think it's vitally important that the states have regulatory authority over these plans with respect to the marketing activities so that states can properly protect their medicare eligible citizens and medicare advantage plans responsible for the acts of their age and the by allowing the states to adopt standardized marketing guidelines as state law thereby as has been mentioned it would add new enforcement ability by allowing state attorneys general insurance commissioners to enforce federal law basically the number of cops on the street so to speak would be increased dramatically and i want to thank  services or will it be the state insurance commissioners amendment specifically to remove the preemption of current what would otherwise be state law it also directs the secretary to issue marketing regulations after receiving recommendations from me and so i would understand this to be both levels of it would be it could regulate this medicare authority has general authority to decide either intermediate sanctions or barring some one from the program we've just been going over the placement of the amendment in the statute to see if we're either or if it's simply allowed  as best i can tell at this point it would allow either up to the secretary's decision she could impose an eight hour media sanction such as a civil money money penalty or she could bar the plan from participating but by the placement of this going from and i i see recommending to the secretary the secretaries and promulgating regs but there is generally in the medicare program and in the medicaid program a departmental appeals board which any dissatisfied contractor or contractor or beneficiary can appeal to a regulatory decision i do not see anything in specific in this amendment which would stop the secretary from using the general departmental appeals board once  the proponents of this amendment are saying we should allow the to regulate those plans and yet as i read the overall structure of this bill it moves all regulation what has to be in a plan what be set at a federal level by the federal government in the bill and all of those things are currently done at least with regard to individual plans at the state level and i guess board recommend what must be covered it goes on and on and on and on and on federalizing all of those things i'd like to ask the proponents of this amendment why this one item  medicare not about the new plan that was the point that i was trying to make before but i take your point that the bill itself functions the federal level and i would only say that the bill does the regulation of insurance at the state level i of my time's expired gentleman from texas time has expired all time has expired on the amendment the question now is on the amendment by ms castor all those in favor of ms cas gentlemen as a point of order i'm sorry point of order has been withdrawn so the question is now on the amendment by ms castor all those in favor of the amendments all those opposed say no the eyes have it and the memmott is adopted we have an amendment on the republican side no no additional amendments do we have any of mr rogers mr rogers chairman clerk will report the amendment within the division and has had the two hours requisite notice it is this gentleman from michigan is recognized thank you mr chairman and you know we have many many concerns with the bill and one of the concerns that we have too is the way the bill has being sold matter fact the president kept telling the american people that quote if you like your plan you can keep it and just this week he told the same thing to thousands of  members during a town hall this is simply on true in the bill c d o analysis also collaborates on that point for seniors this bill is bad news it would cut over one hundred fifty billion dollars from the medicare advantage program virtually wiping out the market for those enhanced plans but in addition this bill cuts hospitals one hundred sixty billion home health services fifty six billion skilled nursing facilities thirty two billion hospice ten billion dollars this really goes after medicare financing in a huge way it's over four hundred billion dollars in medicare cuts are in this bill over ten million seniors are on medicare advantage over two hundred thousand in michigan alone and when you ask are seniors happy with their plan as the president is asked eighty eight percent in fact medicare advantage plans offer additional benefits and often have smaller co payments and deductibles than traditional medicare while they're reimbursed slightly higher than traditional medicare that's because they provide seniors much more than traditional medicare and that's why millions of seniors are making that investment and that choice this bill would gut an innovative program and according to c b s would force million of millions of seniors off of their medicare advantage plans so clearly it is inaccurate to say if you like your plan you can keep it in this bill it says unless you're on medicare advantage and unless you have a health care plan that's to be now older than five years hundreds of millions of americans are going to lose their private health care plan because of this bill in addition this specifically gets at those seniors eighty eight percent who are happy with it are going to lose their plan millions of them and eighty eight percent of them are in the president's words happy with their plan my memon is simple it would require the secretary to certify no seniors will lose access to their current plan before opportunity and i would take the gentleman question seriously except for the fact that you say that somehow you're fiscally conservative on this issue a trillion dollars you really well in my time i'll take any are going to kick people off their plans to do i'll take anyone that you want to oregon thirty nine percent of seniors are on medicare advantage we have the highest medicare advantage penetration rate two hundred ten thousand senior citizens and oregon's health insurance is at risk and it's depending upon the outcome of this me know where where medicare medicare advantage is not offered everywhere but where it is offered it's the fastest growing option that is chosen it has all the wellness provisions in it all the markey it's about your recognized thank you mr chairman this is amendment to clarify one of the great enduring mysteries of the debate about health care and that is where my republican friends stand on the issue of government run health care now on one level it's sacred doctor patient relationship mr blunt said on health care reform the marketplace is the only known mechanism available to deliver what people want and i raise this subject because forty fourth anniversary of president  health insurance company remarkable satisfaction on the part of contractors in the last national scoring that they did of the contractors it got to four point one on a point and frankly we know it works we know that when medicare before medicaid was passed we had a poverty rate of about thirty percent now it's about ten percent we know that the private insurance companies take about two hundred the contradiction inherent in the arguments of many of my friends on the other side this is put up or shut up time if you don't like national health care if you don't like government run health care distinction between a government mandate and a government run plan and medicare is a government mandate there are numerous government mandates and government entitlements having said that the congress sets the requirements of medicare and sets then the then the executive branch issues regulations to implement those requirements to my knowledge at least in my part of the country medicare is operated by private companies under contract to the federal government we have never on the republican side of the said that we oppose at least in this congress in this committee that we oppose medicare my mother would not be alive today if it weren't for medicare she had a heart condition several years ago that was very difficult to treat and she went to houston to the harmon hospital heart center in underwent a two part surgical provision that basically replaced our aorta and it was very complicated cost over one hundred thousand dollars she paid o pocket less than five hundred dollars because of medicare you're never going to hear the ranking member say that he opposes medicare but what we have tried to do when we were in the majority we have tried to use a market system within medicare medicare part d the prescription drug benefit depends upon market competition that numerous private sector drug insurance plans offer their services and senior citizens which any of those plans that they want to get their prescription drug coverage we use a market orientation to implement a government mandate that is a far cry a far government i'd like dominoes back the balance of this time mr murphy they must share and this is not the place and i to have a sweeping prejudicial statements about whether people are hypocritical or dishonest let's stick with something new york presbyterian hospital of ninety three internist affiliated with that hospital thirty seven medicare a med pac survey in two thousand and twenty nine percent of patients on medicare trouble finding a primary care doctor that's up five percent in the last congress there were four hundred fifty two bills introduced by members of congress thirty thousand co sponsors those saying we have a problem with medicare and medicaid let's fix them only twelve  law but it takes an act of congress to change government run health care there is a lot of good things with medicare no doubt about it but let me give you some examples where you have a record an act of congress in order to get intervene in patients must enter a hospital although the therapy can be given at home it's going to take an act of congress and you have situations where medicare might not pay for part of an individual's severe arthritis who can walk a short distance but who may need a power wheelchair for a longer distance outside  and i would just like to make make this point it doesn't happen very often but every once in a while i guess as members we get to vote on amendments that are truly a political farce and that's what this amendment is unfortunate well i tell you what i would love to have conversations with you but i don't have the patience for you to be an intellectual smarty the point here the point here is this was a bipartisan  you know you can beat up on insurance companies all day and some people might make a career out of that but you shouldn't beat up on senior citizens if you wonder why so many are concerned about this government takeover it's because bill koch over five now mr blonde discipline but now amendment mr deal you have an amendment yes mr chairman i have an amendment is e c r one seventy amendment that deals with an area that i think everyone recognizes is one of the most expensive portions of our health care system and one that unfortunately is dealing with health care situation is that are not warranted and that is the emergency room as i'm sure everyone knows the emergency medical treatment and active labor act we commonly refer to as emtala requires emergency rooms to accept individuals for treatment basically without regard to their medical condition the result is that most of the rooms are seeing a predominance of individuals who do not present themselves with what are emergency health concerns in fact in the hospital that is in my hometown and is probably typical of hospitals and most of your on the number one presentation at the emergency room is an ear infection which does not on the most people's definition meet at an emergency the cost in an emergency room are significantly higher than the cost of treating these kinds of problems in a doctor's office or in a health clinic now what this amendment does is it says that if an emergency room doctor has conducted an appropriate screen of the individuals who present themselves and that screening indicates to the doctor that the condition of the patient is not an emergency and therefore is not appropriate i'm in the committee is not in order i can't chairman you like the gentle light of what this says is that if the after a proper screening is done if the individual does not need an emergency room requirement but could be treated at an alternative si a doctor's office or a clinic or some other facility that the doctor who makes that determination after the screening would be afforded the same protection as we afford the doctors who work in community health centers namely they would have the protection the the me would have the protection of the federal tort claims act and the federal tort claims act of course would simply say that here this emergency room doctor who's going through these procedures of screening would have that same protection as if he were working in a community health center now what effect will this have it first of all will have the effect of reducing a significant cost in the health care delivery system it primarily will affect the medicaid program the states and the federal government are paying rather have bills for non emergency services rendered and i think that this is one of the steps that we can take in a commonsense effort to try to save money and at the same time provide the kind of care that is most appropriate for the condition with which an individual presents themselves we are forcing the hospitals and the emergency room doctors emtala to treat these individuals even though they don't meet the want to thank you gentlemen for bringing this amendment forward but people don't realize we've spent the last several weeks talking about individual mandates an employer mandate there exists right now provider mandate for every doctor who is on an active medical staff or who covers an emergency room that they must perform under emtala as mr deal has has outlined one of the big problems is getting doctors all the staff to cover an emergency room and therefore you have doctors who are leaving active medical staff privileges who are going to alternative sites to practice where they won't or they won't be exposed to having to cover an emergency room because precisely because of the very high liability climate this is a small step we can take toward neutralizing that activity and making the provider environment just a little bit more friendly in our nation's emergency rooms and goodness knows we need the surge capacity of all of those doctors who are on the medical staff to be willing to cover emergency room chairman i think one of the things that many people don't understand about the way many emergency rooms are staffed in this country is that much of the care is provided by locum tenens who are actually employed by the hospital and don't have regular full staff privileges to provide emergency care they work for a various number of hospitals in different settings and that has an impact on the ability for that hospital to provide the necessary discipline when bad practices are occurring one of the things that i am concerned about is that this overly broad amendment would take accountability off the table for screening done by medical providers of emergency services and have the government assume fault for any negligence that occurs in the screening process this is a way of shifting the burden from the responsible party the physician staffing the emergency room to the taxpayers of this country that's what the federal tort claims act is set up to do and that's one of the things that i thought was supposed to be the  hallmark of our friends on the other side is really embracing the concept of accepting personal responsibility when you make mistakes that injure or kill people one of the things that we know is taxpayers will end up footing the cost of medical malpracti under this amendment the proposal also lowers the standard of care for uninsured patients it lowers the standard for medical screening services and unlike doctors who are employed at v a hospitals or by federally funded health centers who are actual government employees the government will have no authority to punish or provide additional medical training to private medical providers who provide care below the accepted standard this amendment encourages hospitals and emergency providers to dump patients at other hospitals emtala was an acted by congress to ensure that uninsured and medicare patients would be provided thorough emergency medicare before being transferred to other facilities this amendment makes provision so that it is easier for providers to determine that no emergency medical condition exists allowing them to quickly transfer patients to the facility providing for poor and uninsured patients and it does not specify where those patients are going to be referred to and the whole point of this bill that we're debating is to provide access to primary care which will reduce the burden on our hospital emergency rooms by making sure that patients have access to primary care and that's why there's no reason to single out emergency room physicians for special treatment there's also a little thing that's called the seventh amendment that every member sitting here today swore to support when they took the oath of office and the seventh amendment says that in suits at common which is what a medical malpractise is that the amount and controversy fifteen dollars or more the right to trial by jury isn't viable that that constitutional right in the seventh amendment will be abrogated by the amendment that we're talking about and that's why members need to know that they threaten violating their oath of office by voting to support this gentleman yield to me i'd be happy to there was a comment  made that law consistent for the employees of volunteers at the center they would be covered under the federal tort claims act but in contrast the deal amendment would give the federal tort claims act protection to doctors at private hospitals these doctors are either salaried staff or contract employees are not volunteers they have private insurance it makes no sense to shift costs away from private insurers to the federal thank you miss your men and i appreciate his statement what was in the chairman palauans amendment was something that congress and murphy and i had worked on for the volunteers at federally qualified health clinics we're not talking had illustrates the fundamental misunderstanding indeed the shocking lack of understanding and perception of how emtala works emtala works just like in many ways a federal health care clinic only the doctors who fill the responsibilities under emtala don't get paid at all doctors as were just dr burgess explained a little bit earlier because they're on the staff of a hospital are required to pull hours in the emergency room brayley made the point that we covered doctors who were vide care at a medical clinic created by the federal government as well we should and there is a difference between those doctors and the doctors in the merged at the federal health center  you know not to bring the abortion debate into the health reform debate but from long years of experience in this body and in this committee it's too often a tactic used to poison good pieces of legislation so my colleagues and i have worked on some good compromise language to make sure that we can put this issue to rest and this amendment puts all options in the exchange on a level playing field which is one of our goals no plan neither private or public will be required to cover abortion services similarly no plan will be prohibited from covering abortion services furthermore this amendment is crafted to carefully preserved existing laws that ban federal funds from being used to pay for abortion with the existing exceptions for cases of rape incest or life of the mother the amendment also ensures that no physician or hospital is required to participate in abortion services or apply but private plans in the exchange the only funds that may be used to pay for abortion services would have to come from policy holders on premium subsidies money i repeat public money is prohibited from being used for abortions that aren't allowed under the hyde amendment there is precedent for insurance companies being able to set up separate accounts that are funded with private funding only and as for the public plan this language allows the secretary discretion in covering abortion but also prohibits her or him from using public funds for these services covered abortion services would have to be paid for with private funds that are collected in premium payment finally we specify we specifically spell out that no state laws regarding abortion parental notification or consent are affected or preempted we also cross reference the weld amendment to ensure that no laws on conscience protect protection are affected by this amendment in conclusion i believe this to be a commonsense solution for what is often a very difficult issue and i urge all of and there are strong feelings on both sides of this issue by all the members of this committee and and by the congress what we've tried to do here in this instance is preserve the status quo and a long held principle that i think all americans share whether they consider themselves pro life or pro choice and that is that we not use federal tax dollars to pay for abortion this amendment preserves that status quo no federal funds can be used to pay for abortion except in the case of rape incest or the life of the woman no pro life doctor or hospital or even insurance plan can be required to participate in abortion services no one not the secretary not the benefits committee and not the commissioner can make abortion a part of the minimum benefits package private plans in the exchange can choose to provide coverage for abortion or not it's their decision no public funds may be used to pay for abortions that are not allowed under the hyde amendment the only funds that may be used to pay for other abortion services are funds that come from the policies policyholders on premiums public money is specifically prohibited from being used for other abortions the secretary may choose to allow the public plan to cover abortions not allowed but if they do that they must be paid with private funds no public funds can be used no state laws are are affected about abortion coverage funding procedural court requirements parental notification or consent we preempt no state laws and no federal laws affected on conscience protection or refusal to provide or pay for abortions the weldon amendment is specifically cross rest referenced moreover in this the weldon amendment is extended to cover private plans in the exchange that's a protection beyond will continue the current policy of not mandating or providing taxpayer funding for elective abortions this amendment departs from the longstanding federal policy of hitting funding for plans that include abortion the longstanding federal policy is no federal funding for plans that include abortion and this policy has been applied to medicaid it's been applied to the federal employees health benefits program to the military did in the health system the caps amendment departs from this long standing policy and instead create an accounting scheme by which taxpayer subsidies called affordability credits if you will will go to plans that pay for elective abortion both the  as well by voting for this amendment the committee will be casting a vote in favor of abortion in the government plan subsidizing public and private plans that include elective abortion the result the media federal subsidies for plans that cover elective abortion and both public and private to cover abortions all pro life groups have come out in opposition to this amendment and i think that's a point well taken many people are concerned that because it isn't codified in this amendment that somehow this administration is going to this administration under president  under the caps amendment is there any way possible any loophole any any way in this amendment that federal tax dollars could be used to pay for any abortion that isn't the result of rape incest or the mother's life in danger no chance no loophole not legally not a single penny of federal tax dollars to pay for any abortion that isn't rape incest or the mother's life and that is g if i read this correctly even if that was not enough of an assurance to you and you wanted to find a plan that did not cover service would there be a area that does not cover abortions beyond the hyde amendment so there's two levels of assurance to those who would be uncomfortable one is one is that you can do the dollars so that there's no public dollars going to support those kinds of services but secondly if you didn't even want to be part of a point where that was happening there would be one option available within the  as this debate started off on this amendment i was really disappointed that the author of the amendment said that somehow we use this as a poisonous pill for seventeen years before the author of the congress i worked on these amendments i've never used christianson i miss castor castor i mr sarbanes sarbanes mr murphy of connecticut mr murphy i m michigan and without objection a memo would be considered as read the gentleman from pennsylvania is recognized for five minutes thank you mr chairman h r thirty two hundred will require virtually every individual to have health care coverage that meets the minimum benefit standards the bill then establishes a new government health board called the help benefits advisory committee to determine what qualifies as a minute minimum standard this committee chaired by the surgeon general and in concert with secretary of health and human services will have the power to issue binding decrees on what type of health care coverage individuals must have and employers must provide history has demonstrated that unless abortion is explicitly excluded administrative agencies and the courts will mandate it for example the federal medicaid statute was silent on the issue of abortion but the administration and the courts deemed abortion on demand to be mandated coverage in the case of planned parenthood affiliates of michigan versus engler the circuit court of appeals explained that quote abortion fits within the many of the mandatory categories including family planning outpatient services inpatient services and physician services and some of these same terms such as outpatient services inpatient services and physician services are mandated under this bill if the court terms to mandate coverage of abortion in the one nine hundred seventy s they will surely do it again if the administration doesn't do so first only this time the mandates will apply not only to publicly funded health care but also to private insurance coverage in fact any employer who does not provide coverage that meets the minimum benefit standards will pay up to an eight percent tax penalty and any individual who does not have a plan  benefit standards will be forced to pay a two and a half percent tax this means that americans who do not want a plan for abortion will be penalized for my m m it would simply clarify that nothing in this bill can be used to mandate coverage of abortion under the current plan insurance companies can provide coverage for abortion if they choose and individuals can purchase plans that pay for abortion if they choose security of lives granted in the declaration of independence is for the unborn and for those who attack that that's what this debate is about and this is a great time to go on record amendment says anything about disallowing voluntarily offered abortion coverage that the government can't mandate abortion coverage private plans want to cover abortion this amendment doesn't stop that it stops the mandate to force abortion in every insurance plan in the country the question where the secretary or the advisory committee or commissioner can mandate that covers abortion and if that is not the intent this amendment should pass unanimously and finally on this  i have a copy of that poll it was extraordinarily in favor of the pro abortion participants were left with the impression that the pro life position would result in the lack of access to contraception  interesting that we keep hearing about the caps amendment compromise amendment they must have been compromising among the pro abortion because really the only thing that didn't plan to speak on this but simply cast my vote but i do want to say a few things first of all passions are high and i understand that and i respect that that is on the books that i would acknowledge has not been embraced one hundred percent by the american people there are great tension are the number of voices that leave out what women go through and how women are and the variety of services of the amendment by mr pitt and mr to pack the limitation is it includes simply forcible rape or incest and i want to ask counsel the hyde household and then i'm reclaiming my time i'm reclaiming my time and i think that what i'd like to do is just back at this point because i think people will hold their views i respect that but i appreciate mr chairman especially you're giving me the time to be able to say the things that i did today thank you and thank the others as well as chairman generally backwards time could i ask you to ask consent to remove the word sarbanes sarbanes no mr murphy of connecticut and murphy no mr space our generation will face and hand off to the next generation the gentleman for bringing the amendment forward i think it is one of those one of those areas where we're apt to achieve some significant savings and significant breakthroughs and i'll yield back  particular version of the medical home which is shown great promise especially for people with cognitive impairments people who are homebound i appreciate the work that has been done to produce this language a that whole process that i think is something that we're all going to learn as well because twelve to fifteen million baby boomers are going to have which means in most instances that one other family member will have it with them that is the family member th trying to take care of them so that's twenty four to thirty million americans when the baby boom a category who are going to have to deal with that issue in addition to packets and all the chronic disease and that's why we definitely have to increase the funding and i age research to try to cure these diseases that's for sure but this program will authorize a program that will provide coordinated care to medicare beneficiaries with multiple chronic conditions in their own homes by interdisciplinary teams of health care professionals such as physicians nurse practitioners promises physician assistants social workers and others the project will run for three years it can be extended if the if the secretary determines it should be but it will deal principally with those medicare beneficiaries with monic multiple chronic diseases had difficulty finding a doctor to treat her stating that due to the lack of medicaid doctors medicaid patients often girls while they are hunting for a doctor there are of course similar stories out there every day the difficulties that patients with government health care face on a day by day basis this is not rhetoric to reality and it will be reality for millions more americans who inevitably will be pushed onto the rolls of government run health care if the public plan is part of the health care reform bill a government plan would not compete fairly with private plans like the umpire being on the home team and it does not work so the amendment is fairly simple it strikes all language pertaining to a public plan and specifies in the bill that no federal funds may be used to invest in establishing or operate a government run health care plan now chairman i am committed to helping the millions of americans who want coverage and the lowering costs for everyone i will not however allow that coverage to come in the form of a slow but inevitable takeover of our nation's health care system and that's exactly precisely what the creation of a public option which is probably more appropriately referred to as government insurance will do let me be clear i am not i have not  ever be an advocate on behalf of private health insurance companies but i do believe the role of the government is to play that role of referee or ensuring performance standards are met and that everyone is treated fairly but then it should get out of the way and let american hard work and ingenuity in america know how to do what it does best that's why i think it's so important for this amendment to pass we do not need more government involvement in health care we do not need a government government run health care option now i know it's often quoted that the american medical association is in favor of h r thirty two hundred which includes language for a public option let me just say from the perspective of my colleagues in texas this is not a popular notion so i would encourage members to think of their physicians back home think of their patients let's do the right thing by creating the right kind of system and reject the public option i'll be happy my friend from michigan thank you doctor from michigan and henry ford is a great industrialist there and he said you can have any color car you want so long as it's black and that's all he sold was black cars this is exactly where you're going with this notion on a government run plan and you know i thought that the tirade from my friend from new york was entertaining but the more i listen to him the more i really understood that that is the philosophy where we're going that private plans are inherently bad and can't work for america and we should shove everybody onto a government plan matter fact the lewin study over one hundred million americans will lose their health care as they know what today one hundred million matter fact they said and were willing to use the weight of government to do great things to medicare cut it four hundred billion dollars cut out of medicare hospice home nursing hospitals four hundred billion dollars why because that's the only way the government can control costs by denying access or rationing care that's it look at canada look at the united kingdom in systems that have it that's the only way they can control costs and you're going to take all of these one hundred million people put them onto a government plan that tells dr we will not pay you what it cost to see that patient if you don't think that is trouble brewing look at the health systems in the european system they are dying under the weight of their system and their fact the fastest growing part of their system are people who are escaping it and getting their own private health care insurance americans deserve better people like the states of michigan who built the middle class who built this notion that you could work really hard and oh by the way you get great health care as part of your employment is destroyed by this system if you're a cancer survivor look out if you're somebody who has a serious ailment that takes a very complicated treatment look out because you're going to have to call up to a bureaucrat and hope to god that his calculator is more compassionate and smarter then your doctor back might well reclaim my time and i think the gentleman's passion on this issue this committee our subcommittee on health care to this very room testimony from a borrowing for operational expenses and as a business model for those of you in the room who run your own business you know that is a bottle for survival i urge that affirmative vote for this amendment and i will yield back the additional time and i thank the chairman indulgence  recognition gentleman from connecticut mr murphy i think the chairman and i understand that the public plan is going to become the bogeyman in a lot of this conversation i think it's a lot harder to present the argument if you really reading how this is laid out in the bill there's nothing to be scared of here because this ultimately gets at the issue that a lot of republicans have run on and talked about on the house floor and that's choice that's choice for our for our concern for our constituents for our patients the fact is is that there's no one is going to be forced to the public option it's going to be every individual's choice as to whether they want to stay in private insurance or they want to choose public insurance if you guys are right and the government can't run an efficient product can't put something competitive on the market that it's going to lose out this bill requires of the public option finance itself complete with its own premium so if it can't do a good job of running its own show no one's going to buy into it second is not going to eliminate private insurance we have a cvo estimate that shows us very clearly that not only are there only by their estimate going to be about ten million people to take the public option which by my count is about three percent of total patients across the country but we're actually going to see more people as a result of this bill not less go to private insurance so contrary to the arguments that we've heard though there are going to be about three percent of people in the public option actually more people are going to be less and lastly this mythology that's out there that people have a choice today just isn't rooted in fact of the states in this country have one ensure that control more than fifty percent of the market in some areas especially rural areas in this country there's one insurer the control seventy percent of the market that's no choice for individuals who are trying to go out there and find a more affordable product this bill with a public option gives people that choice and it's not just their choice is doctors choice as well no physician is going to be  their choice as to whether the rates that the public plan pays is enough to bring them so i think this is essential to trying to inject competitiveness into the health care market by giving our constituents patients success of what we are trying to do here and just heard the gentleman talk about the places choices to begin with and so a public choice will make meaningful the idea of choice i also just have today the obvious are private options are for profit the public option will not have that motivating force if you look at the c e o salaries of the top seven private insurers an average nine point seven million and that is an average some are much higher that's enough to cover six hundred and forty eight families with health insurance for a year that's what that is the c e o of the public plan is going to earn a high government salary under two hundred thousand dollars likely maybe somewhere around one hundred fifty thousand dollars the last point i want to make and i realize i've made this point many times before in this committee is to draw your attention to the wisconsin example in medicare part d medicare part d is an exchange in all your states all people have is private options we happen to be very fortunate wisconsin is that we have a public option is called senior care and it's exists by waiver of the department of health and human services this is a very successful program very popular among seniors the cost per enrollee is one third the cost of the private plans that are competing but for all of those who are out there saying that inserting a public option will stifle private competition we have more private sector choices in medicare part d in wisconsin than most other states this has been a singular success to have a public option competing side by side the private option and i will tell you that to a i make no promises not taken because i think this is very very important that there is indeed a heated debate in this nation as to whether or not the offering of a public plan will destroy that insurance there isn't any debate in the minds of some members of congress some single start with a public option let's talk about choice republicans desperately want to believe in choice but what's stopping choice in america is not the absence of a public option what's stopping choice in america t code says that if your employer buys your health care before tax dollars but if you buy your health care you have to pay with after tax dollars that possible for the average american to go buy health care on their own the other members wish to record their vote pack is recognized thank you mr chairman mr chairman or let past thirty five years congress has passed three laws the church amendment the cold amendment in the hyde weld amendment protecting the conscious for health workers especially with regard to abortion employed in allied health professions in denying them the protections that have come to be expected every other federal health care in my district alone we have run charitable hospitals and insurance companies health plans to refuse to provide abortions healthcare providers deserve the protections for their legal right to practice without violating their religious beliefs or moral convictions and on an issue as fundamental as life health care providers should not be forced to band their moral convictions when they come to work i think this issue strikes to the heart of our nation's founding as a place where individuals could be free to practice their religious faith and hindered according to an april eighth two thousand and nine poll commissioned by the christian medical association conducted by the polling company eighty seven percent of americans believe it is important to ensure that health care professionals conscience rights are protected satisfactorily to address that all of those concerns under the bill the sector of h h s has numerous authorities to determine what health insurance must cover in plans but there is no conscience protection to cover to ensure that health care workers or insurers wanting to participate in the exchange are not forced to participate in specific activities they find objectionable so the need for health protections is very clear a lawsuit in ninety seven against valley hospital association this private community hospital in alaska to open its doors for late term abortions the same thing happened in two thousand and two with a catholic operated h m o in new york without these protections our health care writers will be forced to choose between violating their beliefs and leaving their profession or refraining from entering their chosen field together members to protect the right of conscience and support them as explain what the implications of that section provision here is not related directly to abortion services it is any item or service that a health care will continue to work with you because we've got to do all we can to protect children in this country especially low income children to get all the services that they need and i will continue to work with you thank you  system but you know that's not what the president has talked about in fact the president said let me quote exactly what the president said if you like your doctor you'll be able to keep your doctor under our plan period if you like your health care plan health care coverage and they do not want to be forced into a government run health care plan and their opinion it could lower quality it might cost less but there could be long waiting lines there could be rationing and a lack public pot and we're saying we don't want the government to put stipulations commercial private insurance plans that would force americans to move into the public policy by creating a federal regulated health care system government run competing with a private health insurance it won't be long if we're not careful that everybody moving into the public policy but it's if we put ourselves in the position that nothing in this health care plan would commit americans to move into the public policy by mandate by the pricing of this public policy i think we're making a statement which is in agreement with the president has indicated we're actually saying positioning the government as the empire picture in the health care game the government setting the rules calls the balls and strikes controls what kind of delivery is offered so they have a lopsided advantage and so we don't produce a level playing field so my simple amendment is following up with what the president promised what eighty three percent of american families have said when they say i want to keep the coverage that i have and it fulfills basically the promise that americans will be able to keep their health care plan period germany back the balance of his time mr  thank you mr chairman is the chairman i just don't understand why this amendment is necessary because it says nothing in this bill will prevent or limit individuals from keeping their current health benefits plan i mean the fact of the matter is that the bill already permits an indefinite grandfather provision for individual health insurance policy so that means that if you like your individual policy you can keep it as long as you like and as long as it continues to be offered now that doesn't mean that it's likely when to do that because frankly that means it may very well be that it doesn't have essential minimum benefits that we're going to provide that may not have certain protections so i think it's not likely that many people will continue with those individual policies if they can get a better option in the health exchange but they're definitely allowed to keep it indefinitely under this bill now with regard to existing employment based group health plans they're allowed to stay the same for a five year period the reason for that is that and the reason for the shorter grandfather period for job based plans is because the choice of plans an employer makes affects all workers not just  employer and the fact of the matter is that after five years we want to make sure that the essential benefit package and all the other consumer protections that exist under this legislation no discrimination for preexisting conditions for example and other protections kick in because otherwise an employer could decide well i don't want to provide those basic benefits i don't want to provide you know i want to continue with discriminatory policies indefinitely even though the employee decides he doesn't want to do that i don't think that's fair so there is a distinction if you will between individual policies and employer policies for that reason bottom line is people should be able to have a choice if they want a better package and if they want these consumer protections if they don't want to as an individual they don't have to do it they can keep what they have but i don't think that people who have employer sponsored plan should be forced into that situation if they can find it they should be able to take advantage of the better protections and the better benefit package that's being offered i'd like to yield to the gentlewoman from florida and thank blunt for using the time members you need to be very careful with this amendment because what it does it sounds very simple to two line amendment but what it does is it cuts out three or four very important pages of the bill that introduced for the first time very important consumer protections that american families have been clamoring for for many years for the first time americans will not be discriminated against due to preexisting conditions insurance companies will be prohibited from refusing you coverage because of your medical history for the first time no exorbitant out of pocket expenses deductibles or co pays insurance companies will have to abide by your early caps on how much they can charge for out of pocket expenses no cost sharing for preventive care insurance companies must fully cover without charge regular checkups and tests that help you prevent illness such as mammograms and foot exams for diabetics they can't drop coverage if you're seriously ill the insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill no gender based discrimination no annual or lifetime cap extended coverage for young adult children would continue to be eligible for family coverage through the age of twenty six this amendment says health care in america is working like the status quo we need to vote it down because what is happening today is not acceptable for no longer allowed to be discriminated against and the bill would grandfather people in their current plan as preserving the promise that people can keep the coverage they have if they like it but new plans will need to follow the to get the healthiest individuals leaving the sickest in the reform to market it's time to fix the broken marketplace where everyone healthy men and women get access to quality health care and no mr brayley really now mr well well no rush have all members responded to the call of the rule any member wish to change his or her   will report the amendment and i think that is leadership thing for us to do every study you read on this that the other plans would not survive the competition with the public plan i thought we had earlier actually about  amendment first of all there's lots of questions about the public plan the government run plan what's going to be in it and frankly we've been challenged by many constituents you know if missouri appreciate him bringing this amendment for not very strongly oppose this government takeover but for those people who support this if you really think this plan is so good then you should be willing to say that all members of congress should have to enroll in that committee it was voted on in the ways and means committee but it was over in the other body in the health committee which has almost identical jurisdiction on this issue as  care in this in this body so i would hope that we would rule against the point of order it is ready to rule on the point of order this amendment goes into the jurisdiction of the house administration committee which you indicated that you're making this decision because the primary jurisdiction for this committee on this question does not have referral correct are you saying that the house administration does not have i move that the committee reconsider the vote on the amendment by mr numbered one zero zero one point of order mr chairman status point of order i think you have to take the sequence here because i can't recollect whether the roll call was already over when you asked to change your vote i door i miss harman as harmon i  i mr hill to hill i misses christians and this is christian and i miss castor castor this is murphy  any member wish to be recorded about the creation of that public plan indeed many doctors across america are very concerned that a public plan will reimburse doctors at medicare that many of us are aware that doctors across america cannot practice at medicare rates and in many communities across the country it's impossible to find a doctor who will take medicare patients and doctors are more and more saying they won't do that they will no longer accept patients on medicare because they simply cannot accept the reimbursement plan on to the private plan and my m m it simply says that the secretary shall negotiate payment rates for providers under the public insurance option with all health care suppliers and providers and that american medical association made it very clear that it thought reimbursing doctors under the new public option plan on medicare rates would not adequately compensate them and would cause doctors not to want to participate in or practice under struggling to pay their bills under current medicare reimbursement rates they're able to offset some of their losses treating our seniors with higher rates they've negotiated with private plans but this will cease to be the case with millions being pushed into the public plan and once again once again we're going to have coverage without access any public plan to have to negotiate its payment rates and build its own network of providers just as the private system currently does in order to ensure that there's a level playing field for patients and providers mr chairman i oppose the establishment of a public plan but if congress must we must make sure that it will be as fair as possible to all parties involved i have serious concerns that if congress is to enact a public option it will decide to link the reimbursement rates to those already established in other government run plans medicare and medicaid if we force officials to accept the medicare rogers and then to dr gingrey thank you gentleman for yielding i used to be an f b i chicago in the chicago mob used to go into these businesses and say for whatever good or whatever service i'm going to pay you fifty cents on the dollar and by the way if you don't comply i'm going to do something really awful and i look at this bill by the way as an f b i agent i go great good case that's extortion can't wait to get a hold of in this bill the federal government goes into these doctors and says i'm going to pay you eighty  on the dollar and oh by the way if you don't comply i'm going to do some really awful to you i don't know what the differences but we're going to get ready to do it again to these doctors millions of people are going to be pushed into this government plan and doctors are go time is expired chair recognizes themselves in opposition to the amendment this amendment is not the same as the provision in the senate health committee it is only an amendment by itself on th members on both sides of the aisle very clearly stated their opposition to the payment of medicare rights in the public option and express their opposition to requiring providers to mr gordon for thousands of low income seniors across our country adult day health care services are community day time programs to provide health services to the elder seniors who participate in adult day health programs till midnight friday night i would urge the members think carefully about their priorities add we ought to limit the time limit maybe even more than what we did today although it was helpful to have the time limit those that we are in agreement and we we move through them very expeditiously so i think our process today has worked well and i hope that we will consider that or some very similar version of it tomorrow  hate to leave members without an opportunity to offer their amendments we'll do all we can to accommodate members but we're not going to stay up till midnight mr chairman it was the last thing i would indicate to the members of the