19–008 

112TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 112–416 

PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 5) TO IMPROVE PATIENT ACCESS TO HEALTH CARE SERVICES AND PROVIDE IMPROVED 

MEDICAL CARE BY REDUCING THE EXCESSIVE BURDEN THE LIABILITY 

SYSTEM PLACES ON THE HEALTH CARE DELIVERY SYSTEM 

MARCH 20, 2012.—Referred to the House Calendar and ordered to be printed 

Mr. NUGENT, from the Committee on Rules, 

submitted the following 

R E P O R T 

[To accompany H. Res. 591] 

The Committee on Rules, having had under consideration House 

Resolution 591, by a record vote of 7–4, report the same to the 

House with the recommendation that the resolution be adopted. 

SUMMARY OF PROVISIONS OF THE RESOLUTION

The resolution provides for consideration of H.R. 5, the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 

2011, under a structured rule. The resolution provides six hours of 

general debate equally divided among and controlled by the respective chairs and ranking minority members of the Committees on 

Energy and Commerce, the Judiciary, and Ways and Means. The 

resolution waives all points of order against consideration of the 

bill. The resolution provides that an amendment in the nature of 

a substitute consisting of the text of Rules Committee Print 112– 

18 shall be considered as adopted and the bill, as amended, shall 

be considered as original text for the purpose of amendment and 

shall be considered as read. The resolution waives all points of 

order against provisions in the bill, as amended. The resolution 

makes in order only those further amendments printed in this report. Each such amendment may be offered only in the order printed in this report, may be offered only by a Member designated in 

this report, shall be considered as read, shall be debatable for the 

time specified in this report equally divided and controlled by the 

proponent and an opponent, shall not be subject to amendment, 

and shall not be subject to a demand for division of the question 

in the House or in the Committee of the Whole. The resolution 

waives all points of order against the amendments printed in this 

report. Finally, the resolution provides one motion to recommit 

with or without instructions. 


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EXPLANATION OF WAIVERS

The waiver of all points of order against consideration of the bill 

includes a waiver of Section 303(a) of the Congressional Budget 

Act, prohibiting consideration of legislation, as reported, providing 

new budget authority, change in revenues, change in public debt, 

new entitlement authority, or new credit authority for a fiscal year 

until the budget resolution for that year has been agreed to, and 

clause 3(c)(1) of rule XIII, requiring the inclusion of oversight findings in a committee report. 

Although the resolution waives all points of order against provisions in the bill, as amended, the Committee is not aware of any 

points of order. The waiver is prophylactic in nature. 

Although the resolution waives all points of order against the 

amendments printed in this report, the Committee is not aware of 

any points of order. The waiver is prophylactic in nature. 

COMMITTEE VOTES

The results of each record vote on an amendment or motion to 

report, together with the names of those voting for and against, are 

printed below: 

Rules Committee record vote No. 198 

Motion by Ms. Slaughter to report an open rule. Defeated: 4–6. 

Majority Members Vote Minority Members Vote 

Ms. Foxx ............................................................ Nay Ms. Slaughter .................................................. Yea 

Mr. Bishop of Utah .......................................... Nay Mr. McGovern ................................................... Yea 

Mr. Nugent ....................................................... Nay Mr. Hastings of Florida ................................... Yea 

Mr. Scott of South Carolina ............................. Nay Mr. Polis ........................................................... Yea 

Mr. Webster ...................................................... Nay 

Mr. Dreier, Chairman ....................................... Nay 

Rules Committee record vote No. 199 

Motion by Mr. Hastings of Florida to make in order and provide 

the appropriate waivers for amendment #6 offered by Rep. Johnson 

(GA) and Rep. Braley (IA), which would specify that nothing in the 

bill shall preempt any applicable State constitutional provision; 

and amendment #7 offered by Rep. Poe (TX), which would prevent 

the provisions of H.R. 5 from preempting any State law that is in 

effect on the date of enactment of the bill. Defeated: 4–7. 

Majority Members Vote Minority Members Vote 

Ms. Foxx ............................................................ Nay Ms. Slaughter .................................................. Yea 

Mr. Bishop of Utah .......................................... Nay Mr. McGovern ................................................... Yea 

Mr. Woodall ...................................................... Nay Mr. Hastings of Florida ................................... Yea 

Mr. Nugent ....................................................... Nay Mr. Polis ........................................................... Yea 

Mr. Scott of South Carolina ............................. Nay 

Mr. Webster ...................................................... Nay 

Mr. Dreier, Chairman ....................................... Nay 

Rules Committee record vote No. 200 

Motion by Ms. Slaughter to make in order and provide the appropriate waivers for amendment #19 offered by Rep. DeGette (CO), 

which would deny the protections from a health care liability claim 

against a health care organization in the underlying bill to the exVerDate Mar 15 2010 05:15 Mar 21, 2012 Jkt 019008 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\HR416.XXX HR416

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tent such claim is based on an act or omission constituting a violation of the Patient Protection and Affordable Care Act. Defeated: 

4–7. 

Majority Members Vote Minority Members Vote 

Ms. Foxx ............................................................ Nay Ms. Slaughter .................................................. Yea 

Mr. Bishop of Utah .......................................... Nay Mr. McGovern ................................................... Yea 

Mr. Woodall ...................................................... Nay Mr. Hastings of Florida ................................... Yea 

Mr. Nugent ....................................................... Nay Mr. Polis ........................................................... Yea 

Mr. Scott of South Carolina ............................. Nay 

Mr. Webster ...................................................... Nay 

Mr. Dreier, Chairman ....................................... Nay 

Rules Committee record vote No. 201 

Motion by Ms. Foxx to report the rule. Adopted: 7–4. 

Majority Members Vote Minority Members Vote 

Ms. Foxx ............................................................ Yea Ms. Slaughter .................................................. Nay 

Mr. Bishop of Utah .......................................... Yea Mr. McGovern ................................................... Nay 

Mr. Woodall ...................................................... Yea Mr. Hastings of Florida ................................... Nay 

Mr. Nugent ....................................................... Yea Mr. Polis ........................................................... Nay 

Mr. Scott of South Carolina ............................. Yea 

Mr. Webster ...................................................... Yea 

Mr. Dreier, Chairman ....................................... Yea 

SUMMARY OF THE AMENDMENTS MADE IN ORDER

1. Woodall (GA): Would strike the findings in Title I. (10 minutes) 

2. Bonamici (OR): Would delay date of enactment until Secretary 

of Health and Human Services submits to Congress a report on the 

potential effect of this title on health care premiums. (10 minutes) 

3. Hastings, Alcee (FL): Would strike Title II (Repeal of the Independent Payment Advisory Board). (10 minutes) 

4. Dent (PA), Sessions (TX): Would address the crisis in access 

to emergency care by extending liability coverage to on-call and 

emergency room physicians under the Public Health Service Act. 

(10 minutes) 

5. Gosar (AZ): Would restore the application of antitrust laws to 

the business of health insurance by amending the McCarran-Ferguson Act. (10 minutes) 

6. Stearns (FL), Matheson (UT): Would grant limited civil liability protection to health professionals that volunteer at federally declared disaster sites. (10 minutes) 

TEXT OF AMENDMENTS MADE IN ORDER

1. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE WOODALL

OF GEORGIA OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

Page 1, strike line 9 through page 3, line 8 and insert the following: 

SEC. 102. PURPOSE. 

It is the purpose of this title to implement reasonable, comprehensive, and effective health care liability reforms designed to— 


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2. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE BONAMICI

OF OREGON OR HER DESIGNEE, DEBATABLE FOR 10 MINUTES

Page 23, line 22, strike ‘‘date of enactment’’ and insert ‘‘effective 

date’’. 

Page 23, line 24, strike ‘‘date of enactment’’ and insert ‘‘effective 

date’’. 

Page 24, line 2, insert after ‘‘the injury occurred’’ the following: 

‘‘This title shall take effect only on the date the Secretary of Health 

and Human Services submits to Congress a report on the potential 

effect of this title on health care premium reductions.’’. 

3. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE HASTINGS

OF FLORIDA OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

Page 24, strike line 3 and all that follows through the end of the 

bill. 

4. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE DENT OF

PENNSYLVANIA OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

At the end of the bill, insert the following: 

TITLE III—HEALTH CARE SAFETY NET 

ENHANCEMENT 

SEC. 301. SHORT TITLE. 

This title may be cited as the ‘‘Health Care Safety Net Enhancement Act of 2012’’. 

SEC. 302. PROTECTION FOR EMERGENCY AND RELATED SERVICES 

FURNISHED PURSUANT TO EMTALA. 

Section 224(g) of the Public Health Service Act (42 U.S.C. 233(g)) 

is amended— 

(1) in paragraph (4), by striking ‘‘An entity’’ and inserting 

‘‘Subject to paragraph (6), an entity’’; and 

(2) by adding at the end the following: 

‘‘(6)(A) For purposes of this section— 

‘‘(i) an entity described in subparagraph (B) shall be considered to be an entity described in paragraph (4); and 

‘‘(ii) the provisions of this section shall apply to an entity 

described in subparagraph (B) in the same manner as such 

provisions apply to an entity described in paragraph (4), 

except that— 

‘‘(I) notwithstanding paragraph (1)(B), the deeming 

of any entity described in subparagraph (B), or of an 

officer, governing board member, employee, contractor, 

or on-call provider of such an entity, to be an employee 

of the Public Health Service for purposes of this section shall apply only with respect to items and services that are furnished to an individual pursuant to 

section 1867 of the Social Security Act and to post stabilization services (as defined in subparagraph (D)) 

furnished to such an individual; 


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‘‘(II) nothing in paragraph (1)(D) shall be construed 

as preventing a physician or physician group described 

in subparagraph (B)(ii) from making the application 

referred to in such paragraph or as conditioning the 

deeming of a physician or physician group that makes 

such an application upon receipt by the Secretary of 

an application from the hospital or emergency department that employs or contracts with the physician or 

group, or enlists the physician or physician group as 

an on-call provider; 

‘‘(III) notwithstanding paragraph (3), this paragraph 

shall apply only with respect to causes of action arising from acts or omissions that occur on or after January 1, 2012; 

‘‘(IV) paragraph (5) shall not apply to a physician or 

physician group described in subparagraph (B)(ii); 

‘‘(V) the Attorney General, in consultation with the 

Secretary, shall make separate estimates under subsection (k)(1) with respect to entities described in subparagraph (B) and entities described in paragraph (4) 

(other than those described in subparagraph (B)), and 

the Secretary shall establish separate funds under 

subsection (k)(2) with respect to such groups of entities, and any appropriations under this subsection for 

entities described in subparagraph (B) shall be separate from the amounts authorized by subsection (k)(2); 

‘‘(VI) notwithstanding subsection (k)(2), the amount 

of the fund established by the Secretary under such 

subsection with respect to entities described in subparagraph (B) may exceed a total of $10,000,000 for a 

fiscal year; and 

‘‘(VII) subsection (m) shall not apply to entities described in subparagraph (B). 

‘‘(B) An entity described in this subparagraph is— 

‘‘(i) a hospital or an emergency department to which section 1867 of the Social Security Act applies; and 

‘‘(ii) a physician or physician group that is employed by, 

is under contract with, or is an on-call provider of such 

hospital or emergency department, to furnish items and 

services to individuals under such section. 

‘‘(C) For purposes of this paragraph, the term ‘on-call provider’ means a physician or physician group that— 

‘‘(i) has full, temporary, or locum tenens staff privileges 

at a hospital or emergency department to which section 

1867 of the Social Security Act applies; and 

‘‘(ii) is not employed by or under contract with such hospital or emergency department, but agrees to be ready and 

available to provide services pursuant to section 1867 of 

the Social Security Act or post-stabilization services to individuals being treated in the hospital or emergency department with or without compensation from the hospital 

or emergency department. 

‘‘(D) For purposes of this paragraph, the term ‘post stabilization services’ means, with respect to an individual who has 

been treated by an entity described in subparagraph (B) for 


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purposes of complying with section 1867 of the Social Security 

Act, services that are— 

‘‘(i) related to the condition that was so treated; and 

‘‘(ii) provided after the individual is stabilized in order to 

maintain the stabilized condition or to improve or resolve 

the condition of the individual. 

‘‘(E)(i) Nothing in this paragraph (or in any other provision 

of this section as such provision applies to entities described in 

subparagraph (B) by operation of subparagraph (A)) shall be 

construed as authorizing or requiring the Secretary to make 

payments to such entities, the budget authority for which is 

not provided in advance by appropriation Acts. 

‘‘(ii) The Secretary shall limit the total amount of payments 

under this paragraph for a fiscal year to the total amount appropriated in advance by appropriation Acts for such purpose 

for such fiscal year. If the total amount of payments that would 

otherwise be made under this paragraph for a fiscal year exceeds such total amount appropriated, the Secretary shall take 

such steps as may be necessary to ensure that the total 

amount of payments under this paragraph for such fiscal year 

does not exceed such total amount appropriated.’’. 

SEC. 303. CONSTITUTIONAL AUTHORITY. 

The constitutional authority upon which this title rests is the 

power of the Congress to provide for the general welfare, to regulate commerce, and to make all laws which shall be necessary and 

proper for carrying into execution Federal powers, as enumerated 

in section 8 of article I of the Constitution of the United States. 

5. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE GOSAR OF

ARIZONA OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

At the end of the bill, add the following (and make such technical 

and conforming changes as may be appropriate): 

TITLE III—RESTORING THE APPLICATION OF ANTITRUST LAWS TO 

HEALTH SECTOR INSURERS 

SEC. 301. SHORT TITLE. 

This title may be cited as the ‘‘Health Insurance Industry Fair 

Competition Act of 2012’’. 

SEC. 302. APPLICATION OF THE ANTITRUST LAWS TO THE BUSINESS 

OF HEALTH INSURANCE. 

(a) AMENDMENT TO MCCARRAN-FERGUSON ACT.—Section 3 of the 

Act of March 9, 1945 (15 U.S.C. 1013), commonly known as the 

McCarran-Ferguson Act, is amended by adding at the end the following: 

‘‘(c) Nothing contained in this Act shall modify, impair, or supersede the operation of any of the antitrust laws with respect to the 

business of health insurance. For purposes of the preceding sentence, the term ‘antitrust laws’ has the meaning given it in subsection (a) of the first section of the Clayton Act, except that such 

term includes section 5 of the Federal Trade Commission Act to the 


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extent that such section 5 applies to unfair methods of competition. 

For the purposes of this subsection, the term ‘business of health insurance’ shall— 

‘‘(1) mean ‘health insurance coverage’ offered by a ‘health insurance issuer’ as those terms are defined in section 9001 of 

the Patient Protection and Affordable Care Act, which incorporates by reference and utilizes the definitions included in 

section 9832 of the Internal Revenue Code (26 U.S.C. 9832); 

and 

‘‘(2) not include— 

‘‘(A) life insurance and annuities; 

‘‘(B) property or casualty insurance, including but not 

limited to, automobile, medical malpractice or workers’ 

compensation insurance; or 

‘‘(C) any insurance or benefits defined as ‘excepted benefits’ under section 9832(c) of the Internal Revenue Code 

(26 U.S.C. 9832(c)), whether offered separately or in combination with products described in subparagraph (A).’’. 

(b) RELATED PROVISION.—For purposes of section 5 of the Federal 

Trade Commission Act (15 U.S.C. 45) to the extent such section applies to unfair methods of competition, section 3(c) of the 

McCarran-Ferguson Act shall apply with respect to the business of 

health insurance without regard to whether such business is carried on for profit, notwithstanding the definition of ‘‘Corporation’’ 

contained in section 4 of the Federal Trade Commission Act. 

(c) LIMITATION ON CLASS ACTIONS.— 

(1) LIMITATION.—No class action may be heard in a Federal 

or State court on a claim against a person engaged in the business of health insurance for a violation of any of the antitrust 

laws (as defined in section 3(c) of the Act of March 9, 1945 (15 

U.S.C. 1013), commonly known as the McCarran-Ferguson 

Act). 

(2) EXEMPTION.—Paragraph (1) shall not apply with respect 

to any action commenced— 

(A) by the United States or any State; or 

(B) by a named claimant for an injury only to itself. 

6. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE STEARNS

OF FLORIDA OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

At the end of the bill, add the following: 

TITLE III—PROTECTIONS FOR GOOD 

SAMARITAN HEALTH PROFESSIONALS 

SEC. 301. SHORT TITLE. 

This title may be cited as the ‘‘Good Samaritan Health Professionals Act of 2012’’. 

SEC. 302. LIMITATION ON LIABILITY FOR VOLUNTEER HEALTH CARE 

PROFESSIONALS. 

(a) IN GENERAL.—Title II of the Public Health Service Act (42 

U.S.C. 202 et seq.) is amended by inserting after section 224 the 

following: 


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‘‘SEC. 224A. LIMITATION ON LIABILITY FOR VOLUNTEER HEALTH 

CARE PROFESSIONALS. 

‘‘(a) LIMITATION ON LIABILITY.—Except as provided in subsection 

(b), a health care professional shall not be liable under Federal or 

State law for any harm caused by an act or omission of the professional if— 

‘‘(1) the professional is serving as a volunteer for purposes of 

responding to a disaster; and 

‘‘(2) the act or omission occurs— 

‘‘(A) during the period of the disaster, as determined 

under the laws listed in subsection (e)(1); 

‘‘(B) in the health care professional’s capacity as such a 

volunteer; and 

‘‘(C) in a good faith belief that the individual being treated is in need of health care services. 

‘‘(b) EXCEPTIONS.—Subsection (a) does not apply if— 

‘‘(1) the harm was caused by an act or omission constituting 

willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious flagrant indifference to the rights or 

safety of the individual harmed by the health care professional; 

or 

‘‘(2) the health care professional rendered the health care 

services under the influence (as determined pursuant to applicable State law) of intoxicating alcohol or an intoxicating drug. 

‘‘(c) STANDARD OF PROOF.—In any civil action or proceeding 

against a health care professional claiming that the limitation in 

subsection (a) applies, the plaintiff shall have the burden of proving 

by clear and convincing evidence the extent to which limitation 

does not apply. 

‘‘(d) PREEMPTION.— 

‘‘(1) IN GENERAL.—This section preempts the laws of a State 

or any political subdivision of a State to the extent that such 

laws are inconsistent with this section, unless such laws provide greater protection from liability. 

‘‘(2) VOLUNTEER PROTECTION ACT.—Protections afforded by 

this section are in addition to those provided by the Volunteer 

Protection Act of 1997. 

‘‘(e) DEFINITIONS.—In this section: 

‘‘(1) The term ‘disaster’ means— 

‘‘(A) a national emergency declared by the President 

under the National Emergencies Act; 

‘‘(B) an emergency or major disaster declared by the 

President under the Robert T. Stafford Disaster Relief and 

Emergency Assistance Act; or 

‘‘(C) a public health emergency determined by the Secretary under section 319 of this Act. 

‘‘(2) The term ‘harm’ includes physical, nonphysical, economic, and noneconomic losses. 

‘‘(3) The term ‘health care professional’ means an individual 

who is licensed, certified, or authorized in one or more States 

to practice a health care profession. 

‘‘(4) The term ‘State’ includes each of the several States, the 

District of Columbia, the Commonwealth of Puerto Rico, the 

Virgin Islands, Guam, American Samoa, the Northern Mariana 


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Islands, and any other territory or possession of the United 

States. 

‘‘(5)(A) The term ‘volunteer’ means a health care professional 

who, with respect to the health care services rendered, does 

not receive— 

‘‘(i) compensation; or 

‘‘(ii) any other thing of value in lieu of compensation, in excess of $500 per year. 

‘‘(B) For purposes of subparagraph (A), the term ‘compensation’— 

‘‘(i) includes payment under any insurance policy or 

health plan, or under any Federal or State health benefits 

program; and 

‘‘(ii) excludes— 

‘‘(I) reasonable reimbursement or allowance for expenses actually incurred; 

‘‘(II) receipt of paid leave; and 

‘‘(III) receipt of items to be used exclusively for rendering the health services in the health care professional’s capacity as a volunteer described in subsection 

(a)(1).’’. 

(b) EFFECTIVE DATE.— (1) IN GENERAL.—This title and the amendment made by 

subsection (a) shall take effect 90 days after the date of the enactment of this title 

(2) APPLICATION.—This title applies to any claim for harm 

caused by an act or omission of a health care professional 

where the claim is filed on or after the effective date of this 

title, but only if the harm that is the subject of the claim or 

the conduct that caused such harm occurred on or after such 

effective date. 

Æ 


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