Michael Burgess

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I demand a recorded vote.

Mr. BURGESS

Mr. BURGESS. I yield myself 30 seconds. Mr. Chairman, we just heard a moment ago from the gentleman from New Jersey perpetuation of the fantasy that the Patient Protection and Affordable Care Act is going to save anyone in this universe or a parallel universe or a parallel dimension any money. Make no mistake: This law costs vast sums of money. When the subsidies and the exchanges hit, the tap on the Federal Treasury is going to be unlike anything this country has ever seen. Congressional Budget Office talk about saving money was pure fantasy. The chief actuary for the Centers for Medicare & Medicaid Services exposed that fantasy for what it was less than 1 month after Congress voted on this bill. We voted on this law without actually having correct information because I believe the Secretary withheld the information from us. I reserve the balance of my time.

Mr. BURGESS. Mr. Chairman, I yield myself 1 minute. The Federal deficit is now the biggest concern of business economists and, indeed, the American people at large. Job creators are sitting on the sidelines while Washington continues to spend more money that it doesn't have. Despite the sobering facts, my colleagues on the other side of the dais in the Energy and Commerce Committee have not proposed a single cut, not one single spending cut under our committee's jurisdiction. Now, sure I can be criticized today for only trying to save, what, $200 million? I don't know about New Jersey, but in my district back in Texas, $200 million is still real money. When challenged at last week's subcommittee markup, all Mr. Waxman could come up with were tax increases and cuts to the farm program. We can and should do more to get our spending under control. Our committee, the Committee on Energy and Commerce, has an obligation to be front and center in that fight. I reserve the balance of my time.

Mr. BURGESS. I yield 30 seconds to the gentleman from Georgia (Mr. Kingston).

Mr. BURGESS. Mr. Chairman, may I inquire as to the amount of time that is left?

Mr. BURGESS. I would agree that it is going to be an uphill battle in the Senate, but I believe we can be successful. I would just point out to the gentleman that the President has not issued a veto threat against this legislation. At this point, I yield 2 minutes to the gentleman from Georgia (Mr. Kingston).

Mr. BURGESS. Mr. Chairman, I yield 1 minute to the gentleman from Georgia (Mr. Graves).

Mr. BURGESS. I yield the gentleman an additional 30 seconds.

Mr. BURGESS. Mr. Chairman, I yield 3 minutes to the chairman emeritus of the full Committee of Energy and Commerce, the gentleman from Texas (Mr. Barton). (Mr. BARTON of Texas asked and was given permission to revise and extend his remarks.)

Mr. BURGESS. Mr. Chairman, I would just point out to the gentleman how shortsighted and misguided that is, that this language was put in by the Senate when they were giving out favors. Sending checks to localities without guaranteeing the actual coverage, without guaranteeing the actual doctor or nurse be there, does not do anything as far as furthering care. I would now yield 2 minutes to the gentlelady from North Carolina (Ms. Foxx).

Mr. BURGESS. I yield the gentleman an additional 30 seconds.

Mr. BURGESS. Mr. Chairman, let me respond to something that was just said by the chairman emeritus of the Democratic side of the Committee on Energy and Commerce. Of course I have all respect for the chairman emeritus and certainly treasure every day that I served under his direction as chairman in two Congresses. But the statement that I cannot let stand is that the Patient Protection and Affordable Care Act saves anyone in any universe, in any dimension, any money at all. This was refuted by the chief actuary for the Centers for Medicare & Medicaid Services less than a month after the President signed the Patient Protection and Affordable Care Act. I do not know why we have to continue to hear this fairy tale about $142 billion being saved under PPACA. At this point, I would like to yield 2 minutes to the gentleman from Louisiana, Dr. Fleming.

Mr. BURGESS. I yield myself such time as I may consume. Mr. Chairman, here is the simple truth. What takes health care away from children is sending checks to localities for land acquisition when you've got no intention of staffing the clinic that is going to be built. Let me just remind people what the argument is about, and I will stipulate that we are not talking about a vast sum of money here like we were in the previous bill. But every instance of advance appropriation in the Patient Protection and Affordable Care Act represents an opportunity for this Congress to reclaim some of its function as the people's House in being in control of Federal spending. But here's what the argument is about. Section 4101(a) of the Patient Protection and Affordable Care Act under subtitle B, increasing access to clinical preventive services, paragraph 5 of 4101(a), appropriations: out of any funds in the Treasury, not otherwise appropriated, there is appropriated for each of the fiscal years 2010 through 2013 $50 million for the purpose of carrying out this subsection. Funds appropriated under this paragraph shall remain available until expended. No funds provided under a grant awarded in this section shall be used for expenditures for personnel or to provide health services. It could not be clearer. Now, nothing in the bill that we have under consideration today actually does anything to the provision of services because, after all, those are under an authorization. Section 4101(b), authorization of appropriations: for purposes of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2010 through 2014. But the operative words here--``there are authorized to be appropriated''--not that there are appropriated from the Treasury. It's okay for us to authorize that appropriation. Our committee is an authorizing committee. We are not an appropriating committee. Mr. Chairman, I understand the difference between an authorizing committee and an appropriating committee. I take an annual field trip to the National Institutes of Health. At the National Institutes of Health you see all these beautiful buildings. They are all built, and they're named after very famous men who served in the United States Congress. Every one of those men is an appropriator. There is no building named after an authorizer. Still, the work we do is important--I submit it is vital--to the American people that we do our work to evaluate whether or not the expenditures are indeed in the best interest of the American people; and, further, if we're really doing our job, we'll come back and do oversight over those authorizations to make sure those funds are expended in the manner in which they were intended. That's the way you guarantee that that care gets to the child that will ultimately save money to keep the child out of the emergency room, not just by sending checks to localities to purchase land. I reserve the balance of my time.

Mr. BURGESS. I yield myself such time as I may consume. And nothing in the bill under consideration, H.R. 1214, would change anything about what was just relayed to us about the school-based clinics in the gentleman's district. Can I just point out, again, that the discussion that we're having today revolves around the use of advance appropriations in the Patient Protection and Affordable Care Act, thereby making that spending mandatory. Now, just a brief civics lesson. Medicare is mandatory spending. We have no discretion on that. We must fund Medicare to the extent of the number of dollars that are going to be drawn on the Federal Treasury. Same for Medicaid. We have other health care programs that are, in fact, discretionary. Our veterans, who I'm sure the gentleman would argue are no less worthy, are funded under a discretionary program. The difference between a mandatory and a discretionary program is that the authorizing committee, in this case the Committee on Energy and Commerce of which I am a member, of which the gentleman from New Jersey is a member, the authorizing committee sits down and decides whether or not the spending is useful. If it is, we authorize the expenditure. We send it over to the appropriations committee who, if they agree, writes a check for the amount of money that we have authorized and not one bit more. But the key here is it goes through a regular order process; and one of the things, I don't know about the gentleman from New Jersey, but what I heard when I went home is the Federal spending is out of control; you've got to get a handle on Federal spending. Well, here's a point where we can get a handle on some Federal spending. It should never have been an advance appropriation in the Patient Protection and Affordable Care Act. I don't know whether that was carelessness or Machiavellian, but it doesn't matter. It's got to be fixed. The American people want us to fix that. That was one of the reasons they voted en masse against the Patient Protection and Affordable Care Act November 2, 2010. That is one of the reasons that the gentleman is sitting in the Speaker's chair today is the public revulsion to how last Congress conducted its business. We have a chance now to reclaim a little of our honor, a little of our integrity. Let's bring that funding back into the authorization realm in which it belonged and not simply pass it off to the administration. It's mandatory funding. It has to be done. Whether or not the administration is going to fund a doctor or nurse to work in that clinic, you've got an exam bed, you've got a thermometer, you've got a sphygmomanometer, but you don't have one ounce of care delivered to the people who actually need it. Therefore, you are not saving money. You are only spending money. The American people have asked us to be wiser stewards with their cash. I reserve the balance of my time.

Mr. BURGESS. I yield myself 1 minute. Mr. Chairman, this language was put in the Senate's health care bill when the Senate was giving out favors, and there really was no rhyme or reason to put this program in as a program under mandatory funding. Congress has traditionally provided funds to health centers, including school-based health centers, to provide for care, not for construction. To do it the other way around would lead to situations where a center is built but no care is delivered. Both policy choices require local funds to be spent, but only the policy for paying for services, not construction, guarantees that money won't be wasted or, worse yet, never used to deliver 1 ounce of care. I reserve the balance of my time.

Mr. BURGESS. Mr. Chairman, I yield myself 1 minute. This mandatory spending was not in H.R. 3200, the House-passed health care reform bill. Make no mistake, I voted against 3200 just as I voted against 3590. But, nevertheless, the bill that subcommittee Chairman Pallone last Congress brought through did not have mandatory spending for school-based health centers in his bill. Some of us get up today and act as if mandatory spending for this program is imperative, that it's the only way to go, that we can't provide care if we don't have mandatory spending for building the exam room. But, again, I remind my colleagues on the other side that simply an exam room with an exam table, a thermometer and a sphygmomanometer does not provide 1 ounce of care to a child. It does not save any money in an emergency room visit. It is simply an exam room sitting unutilized because the President of the United States said, I'm going to zero out the discretionary funding for staffing these clinics. That's why this makes no sense. I urge, again, support for the underlying bill. It is important to bring this back into the authorization process so our appropriate committees can have the oversight over the expenditure of these funds. I reserve the balance of my time.

Mr. BURGESS. Mr. Chairman, I move that the Committee do now rise.

Mr. BURGESS

Mr. BURGESS. Mr. Chairman, I move that the Committee do now rise.

Mr. BURGESS. I thank the chairman. I would just say, once again, the flexibility does not exist. It's a veneer, it's a falsehood that under this plan the States would maintain flexibility. The Secretary determines whether or not the States are complying. The Secretary determines whether or not the plans are in compliance with what the Secretary thinks is a reasonable plan to be offered. If we want to talk about the ability of people to buy insurance across State lines, that's an argument that we can and should have. I don't know why your side rejected that in the debates over the Patient Protection and Affordable Care Act. The fact of the matter is, they didn't. We are where are. Let's defeat this amendment and support the underlying bill. I yield back the balance of my time.

Mr. BURGESS. I yield myself 4 minutes. My colleagues on the other side of the aisle have argued that these grants encourage flexibility by promoting State control of the exchanges. Yet this argument is based on the premise that States can actually design the right health care plan for their citizens under the Patient Protection and Affordable Care Act. But when you look at the law, you understand that this concept is actually not true. In reality, the relationship between the States and Washington, the States are the servant, not a partner of Washington under this health care law. The Secretary of Health and Human Services will control what benefits must be bought, must be bought, in an exchange. A benevolent central planner, and I underscore the word ``benevolent,'' but a benevolent central planner will decide whether you, your doctor, your nurse, your clinic, your hospital can provide care to you through an exchange plan. A regulation writer at the Department of Health and Human Services will decide whether or not your health savings account complies with their rules. Rather than promote local control, the Patient Protection and Affordable Care Act's exchanges have only the veneer of providing States flexibility, and they certainly rob an individual and they rob families of health care choice, even if they are happy with the coverage that they currently have. The Welch amendment does not authorize a grant program for States to establish exchanges, that is exchanges written with a lower case E, but, rather, Health Benefit Exchanges, all caps, that are contemplated in the Patient Protection and Affordable Care Act. Section 1321 of the bill has the title ``State Flexibility in Operation and Enforcement of Exchanges,'' but a reading of that section shows the title could not be anymore misleading. The section is littered with phrases such as ``other requirements the Secretary determines appropriate,'' or words such as ``the Secretary determines that an electing State has not taken the actions the Secretary determines necessary.'' Section 1311(k), I have referenced that previously, section 1311(k) states that ``an exchange may not establish rules that conflict with or prevent the application of regulations issued by the Secretary.'' Mr. Chairman, I am encouraged that the supporter of the amendment believes that we should not provide the Secretary with a blank check. However, I oppose this amendment because it perpetuates the idea that the Federal Government should dictate how States establish exchanges. Last year, we were told we need to read the bill to know what is in it. Today, I ask those here in this body to ignore the rhetoric and actually read the bill. Those who do will clearly see that any suggestion that the Patient Protection and Affordable Care Act provides States flexibility does not hold up to the words in this 2,700-page bill. I reserve the balance of my time.

Mr. BURGESS. Mr. Chairman, I rise in opposition to the amendment.

Mr. BURGESS. I yield myself the balance of my time. The Patient Protection and Affordable Care Act, as seductive as the title sounds, does not empower the States. In fact, it does just the opposite. Some States have created or are in the process of creating State exchanges that would not meet the requirements set forth by Washington. For these and other States that don't believe that Washington knows best, I oppose this amendment. I urge my colleagues to oppose the amendment. I urge my colleagues to support the underlying bill. I yield back the balance of my time.

Mr. BURGESS. Mr. Chairman, I yield myself 4 minutes. The description provided by the author to the Rules Committee states that the amendment ``would require the Government Accountability Office to report on benefits of funding in setting up State-run exchanges that reflect the State's marketplace, as opposed to State exchanges established and operated by the Federal Government.'' That description sounds appealing enough in its own right; but sort of like the health care reform law of last year, you have to read the amendment to find out what is in it. The amendment does not ask the Government Accountability Office to examine the benefits of State-run health insurance exchanges. Rather, the amendment asks the GAO to report only the exchanges called for in the Patient Protection Affordable Care Act, whose rules and structure are dominated by Washington rather than States or individuals. The amendment description speaks to ``setting up State-run exchanges that reflect the State's marketplace.'' However, talk about State flexibility in the Patient Protection and Affordable Care Act is just that: it is merely talk. I would remind my colleagues about the Golden Rule: He with the gold makes the rules. So let's once again look at just a few areas where Washington will dictate operation and structures of the exchanges. For the purposes of comparison, let me use Washington versus Austin, the capital of my State. So will Washington or Austin choose the essential benefits that must be paid for by the individuals and families? Section 1302 of the Patient Protection Affordable Care Act says that responsibility is Washington's. Will Washington or Austin control whether health savings accounts and other consumer-driven plans can be offered? Section 1302(d)(2) says Washington wins that round. What about, will it be Washington or Austin that will select the doctors and other health care professionals that are allowed to provide care in the exchange plans? Well, section 1311(h) gives that authority to Washington, not Austin. Washington or Austin to decide if your plan's provider network is adequate regardless of whether or not it covers your doctor? Section 1311(c)(1)(B) gives that authority to Washington, DC. Will it be Washington or Austin to decide whether a plan provides linguistically appropriate and culturally sensitive information? Section 1311(i) gives the nod to Washington. Will it be Washington or Austin that determines whether a State plan is properly accredited? Well, once again, section 1311(c)(1)(B), Washington wins that round also. Washington or Austin, who do you think is going to win this one, can decide when individuals can enroll in an exchange plan? Section 1113(c)(1)(I)(6), Washington, DC wins that one. Washington or Austin, impose certification and decertification plan requirements written by the Department of Health and Human Services? Well, that's hardly fair because HHS is in Washington, and, you guessed it, Washington wins that round. Washington or Austin, who do you think is going to win this one: judge the adequacy of an exchange Internet Web site? That's something that the States should be able to decide. After all, who knows the residents of the State better than Austin in the State of Texas? Well, Washington actually wins that round. How about this one: Washington or Austin, force State government to pay for existing benefit requirements? Well, guess what, Washington, not the State. Washington will be the one making that determination. Then under section 1321, If the Secretary determines a State has not taken the necessary steps, as determined by the Secretary, to meet all the requirements set forth by the Secretary, then the Secretary will take over the State exchange. I think, Mr. Chair, you begin to get the impression that this is not State flexibility; this is of and run by Washington, DC. I reserve the balance of my time.

Mr. BURGESS. Mr. Chairman, I rise in opposition to the Pallone amendment.

Mr. BURGESS. Mr. Chairman, I will direct my remarks to you and will try not to make them personal, but I am offended that the previous speaker would say that I am attacking the Secretary of Health and Human Services. Nothing could be further from the truth. The fact of the matter is, Mr. Chairman, that the Patient Protection and Affordable Care Act that was pushed through this Congress by then- Speaker Pelosi and members of the Democratic Caucus gave the Secretary of Health and Human Services unprecedented power. With regard to every man, woman and child in this country, the most intimate aspects of their lives are now controlled by the Secretary of Health and Human Services. Further, every time in this law where it reads ``and the Secretary shall--'' and I believe there are almost 2,000 of those phrases--there is a new episode of a Federal rulemaking. There are thousands of pages that go in the Federal Register. Now, I know most people spend part of their nights reading the Federal Register every evening; but for those who don't, these regulations are coming at you at an alarming rate. Let's be honest about the insurance companies. The insurance companies love this bill. They get an individual mandate: you've got to buy their product. You have no choice. It is a mandate enforced by the Secretary and, oh, by the way, by the Internal Revenue Service. Look, this is a bad amendment. Let us defeat this amendment. Support the underlying bill. I yield back the balance of my time.