Ann Marie Buerkle

Ms. BUERKLE

Ms. BUERKLE. I thank the gentleman from Michigan. Mr. Speaker, we've touched upon it, and I want to continue having this conversation about the effect that the Affordable Care Act is going to have on our hospitals in our Medicare population. Now, Mr. Speaker, you may have heard over and over again from our colleagues from the other side of the aisle, demagoguing our budget proposal that came out in April. They say we want to kill Medicare; we want to kill Social Security; we don't care about our seniors. Tonight I stand here, Mr. Speaker, and I tell you, and I want to tell the American people, that the Affordable Care Act, in fact, cuts Medicare spending by $500 billion. Those are actual cuts that are now in the Affordable Care Act, or what is known as the health care law. One of the most negative effects is the result of reductions in hospital Medicare payments and the CMS code, offsetting reductions to hospital payment plans. I have a chart here, Mr. Speaker. And as I go through my notes, I want it to be clear that you can see 2010 and what happens to Medicare reimbursements, down until 2018. Our hospitals can't sustain these cuts. The five hospitals in my district have come to me, and they said, This Affordable Care Act--and many of these hospitals were big proponents of the Affordable Care Act because they know in our country we need to reform our health care system, we need to make some changes, so they were in support of the law. But what they didn't realize was this law is going to cut their Medicare reimbursements, which so many of them depend on. It's the mainstay--by 28.6 percent. I've had hospitals in my district say to me, We cannot sustain these cuts. We will go bankrupt. Because you see, Mr. Speaker, it's not only this Medicare, the reduction in these rates, but it also is a series of other cuts which we will get into as the evening proceeds. I yield to the gentleman from Georgia.

Ms. BUERKLE. I thank the gentleman from Georgia. I have spent most of my professional career in the health care industry. I have represented a hospital for a number of years, so I know up close and personal how these issues have affected and will affect our hospitals and our providers. And despite the best intentions of this health care law--whether we disagree with it or we agree with it--despite the best intentions of this health care law, what we are seeing are the unintended consequences. The fact that our hospitals, our health care providers, will not be able to proceed, will not be able to perform the services that our communities need and expect and have come to expect. That certainly wasn't the intent of the health care law, but ladies and gentlemen and Mr. Speaker, that's exactly what is happening. I would like to yield and recognize the gentlewoman from North Carolina.

Ms. BUERKLE. And I thank the gentlelady from North Carolina for being here this evening. I would just like to continue on because of my concern, and I know my colleagues have such concerns, about the health and the well-being of their hospitals. As I mentioned earlier, they are the largest employer in my district. We refer to it as ``eds and meds.'' We have a large university there and some colleges, but we also have five hospitals in my district. So our reliance for our local economy and for our State economy is just so very important. I want to talk a little more about what this health care law is going to do to Medicare and do to our hospitals. There is $112 billion in reduced market basket updates to hospitals. There is a $36 billion reduction to Medicare and Medicaid disproportionate share hospital payments. Now, Mr. Speaker, disproportionate share may sound a little confusing. I'm going to explain what that is. In a district such as mine, we have hospitals that have missions. And I'm sure across the country, many hospitals have missions. They want to make sure that the indigent population, folks who can't afford insurance, who are self- pays or maybe are on Medicaid, that they have access to quality services. So the government says to these hospitals, we understand that Medicaid reimbursements or self-pay patients will not cover your services. So what we're going to do is, we're going to try to make you whole with this disproportionate share. Mr. Speaker, the health care law eliminates the disproportionate share for hospitals, and so hospitals that have a high indigent population or a high number of self-pay patients or those who are on Medicaid, they are not going to get that disproportionate share. The hospital in my district came down here. It is a large teaching institution. They made a special trip down here to tell me that provision of the health care law will bankrupt them. They probably receive somewhere around $80 million a year to make them whole because of their mission. And isn't that what we want? We want to make sure-- and wasn't that the original intent of the health care law?--to make sure that there was accessible care for all Americans. But here again we reached the unintended consequences, and the effect that this law is going to have on our hospitals. There is a $7.1 billion reduction for readmissions. We will talk about that in a little bit. Hospitals, and many of the ones in my district, and I know throughout this country, they are heavily dependent on Medicare and Medicaid dollars. And with that narrow margin, Medicare and Medicaid don't even cover their costs. And so there's such a small margin for them to operate that there's really little capacity for improvements. Realistically, hospitals--especially teaching hospitals and hospitals that are treating the underserved--cannot bridge that gap, and they won't be able to bridge that gap because of this new health care law. Hospitals must be able to invest in their infrastructure. Having such a narrow margin and/or no margin operating in the red, they're not going to be able to do that. They're not going to be able to invest in infrastructure, systems improvements, new techniques to reduce hospital-acquired infections, new models of delivering health care and electronic health records. And I want to talk about electronic health records because they were mandated in the health care law. The Affordable Care Act mandates that hospitals must move to electronic health records. Now, from a patient safety standpoint, that's a good thing, but getting hospitals up to speed and getting them ready for business has very high IT costs for our hospitals. So, again, you've got this health care law mandating electronic records, and you've got these drastic cuts to our hospitals in their Medicaid and Medicare reimbursements. I yield to the gentleman from Georgia.

Ms. BUERKLE. I thank the gentleman from Georgia. Mr. Speaker, I want to just emphasize again with regards to this health care law and the fact that this law--and, Mr. Speaker, this is a law, this isn't a budget proposal, this is a law--guts Medicare by $500 billion. It should be of concern, Mr. Speaker, to our seniors because this law, in fact in 2014, will begin to gut Medicare. I again would look at this chart and the Medicare reimbursements. There will be no hospitals that will be able to provide health care. If you look at what the trend is for Medicare reimbursements to our hospitals, they cannot continue to exist based on what is set forth in the Affordable Care Act. I spoke with the CEO of one of our local hospitals, Crouse Hospital in Syracuse, and he spoke with one of my health care staff; and he indicated to us today that Crouse Hospital, one hospital in the district, is facing a projected loss of $18 million in reimbursement reductions. That number goes to access to care. We can have the most comprehensive health care law on the books, but if we don't have hospitals who are able to provide that care, and we don't have physicians who are able to provide that care, we will have access-to- health-care problems. Mr. Speaker, earlier I talked about hospital readmission penalties. This is another concern hospitals have to deal with. And tonight we've talked a lot about what the Affordable Care Act will do to hospitals, the effect that it will have on our hospitals, the drastic cuts in Medicare and Medicaid reimbursements and the disproportionate share being eliminated. But our hospitals are under assault from all sides, and that's part of the difficulty. Maybe they could somehow figure out how to deal with these cuts in the Affordable Care Act; but taken in its totality, our hospitals are having a very difficult time. In fact, as I mentioned earlier, many are concerned that they will be unable to sustain and unable to continue on with their services, given the whole assaults that are coming from all directions. And this actually is part of the Affordable Care Act. It establishes a punitive policy for our hospitals when they readmit a patient. And I will explain that, Mr. Speaker. Under the health care law, the Affordable Care Act--we call it the Affordable Care Act, we call it ObamaCare, we call it many things--but under this new law that is taking effect gradually, under this to their expected readmission rates, if even more than one readmission occurs--and that readmission means that you discharge a patient, the hospital sends a patient home and then for some reason they have to come back. If that happens with one of three diagnoses within the Medicare scheme, the hospital will be penalized for all of the Medicare reimbursements, not just that one case where there was a readmission, but all of the Medicare reimbursement cases. You can imagine the magnitude and how that will affect Medicare reimbursements. The other part of this provision in the health care law is that it really doesn't discern between what's avoidable and what's not avoidable readmission. So sometimes a hospital may discharge a patient and it was premature, or something wasn't done and the patient needs to come back. And certainly that should be considered, and we should figure out what went wrong because readmissions are expensive, and so Medicare doesn't want to pay for them. And I understand that. However, some readmissions are unavoidable, and a hospital shouldn't be penalized for an unavoidable readmission; and yet the Affordable Care Act does exactly that. The Secretary of the Department of HHS, Health and Human Services, which has the authority now to expand what were three diagnoses, now has the authority to expand that list of conditions with regards to readmissions. Hospitals nationwide, Mr. Speaker, are projected to face more than $7 billion in Medicare reductions over 10 years because of this policy, $7 billion to our hospitals. We began this discussion tonight, Mr. Speaker, talking about the importance to our local economies, the employment numbers, what hospitals pay into our community with their purchases and with their employees, the taxes that they give back to the community; and now we're talking about cutting them again because of this policy. You know, the issue of hospital readmission is complex, and I hope I did a good enough job tonight of explaining it. And while health care providers agree there's always room for improvement across the continuum of care, readmissions occur for many reasons. And punitive action via reduced reimbursements is not only counterproductive, but it's also potentially harmful to our hospitals, to our patients, and to our communities. Mr. Speaker, as we work hard to make sure our seniors get the Medicare benefits from the system that they have paid into--and, Mr. Speaker, I want to emphasize that over and over again during the course of this hour, our seniors have paid into Medicare, into the health care system all of their life. And now, as they reach the Medicare eligibility age, they deserve to get Medicare coverage that they expect, that they deserve, and that they've paid into. But this health care law, this $500 billion cut to Medicare, is going to change that for our seniors. It's not the budget proposal in April that's going to--that was a budget proposal. And you've heard my friends and colleagues across the aisle demagogue our budget proposal in April, saying we want to cut benefits to seniors, Medicare, and Social Security. The fact is, Mr. Speaker, this health care law, passed into law in 2009, will devastate Medicare. And our seniors, Mr. Speaker, should be very, very concerned about this Affordable Care Act. Not only will it affect our hospitals--as we've spent so much time talking about tonight--but it will also affect the care and the access to care for our seniors. Hospitals, Mr. Speaker, already operate on such thin margins, and we talked about this earlier, that for many providers, especially specialized programs, treating patients struggling, say, with substance abuse or helping the developmentally disabled, they will be reduced or they will end those programs. Hospitals cannot operate on such a thin margin and then run the risk of all of these devastating Medicare and Medicaid reimbursements. Mr. Speaker, I also want to speak tonight a little bit about graduate medical education. As I mentioned earlier, I was an attorney in Syracuse, New York, and I represented a hospital that was a large teaching hospital. And so I know how much they rely on what's called graduate medical education. We often refer to it as GME, sort of the acronym for it, the initials. I'm going to explain what GME is because it's so important to our hospitals. And even hospitals that don't have a medical school attached to them, we'll talk about some of the reimbursements they get because medical students and residents train within these facilities. Graduate medical education is the training medical school graduates receive either as a fellow or an intern or a resident. Medicare is the largest contributor to the GME. Now, why do I even bring this up? I bring this up because we talked earlier about the many assaults on health care providers, the many assaults that hospitals are concerned about. This is not per se in the health care law, so I want to make that clear. But when it comes to cutting, when it comes to finding and helping this terrible national debt that we have that is now $15 trillion, often we look to Medicare. And one of the areas in Medicare, the low-hanging fruit--whether it's a hospital or a physician--that seems to be the easiest place to go to rather than really looking at our health care system, making it a free market, allowing the market to compete, getting the government out of health care and letting folks buy insurance across State lines. Rather than letting the free market in it, we have the government involved. So Medicare is the largest contributor to this GME. GME payments, as I mentioned, have been targeted. They've become a target for recommended budget savings. In 2010, the President's Simpson-Bowles Deficit Commission recommended limiting hospitals' GME payments to 120 percent of the national average salary paid to residents in 2010, and reducing another reimbursement the hospitals get, the IME, the indirect medical education, by 60 percent, from 5.5 to 2.2 percent. Mr. Speaker, these two changes--Medicare reimbursement to the GME, Medicare reimbursement to the IME--would reduce Medicare medical education payments by an estimated $60 billion through 2020, $60 billion. Mr. Speaker, these aren't just numbers. These proposed cuts would endanger the ability of teaching hospitals to train physicians. We must face the fact that cuts to graduate education would result in fewer practicing physicians and ultimately reduced access to care, which is getting back to why there was an Affordable Care Act. I talked about this road paved with good intentions. And now what we are seeing is that our hospitals, our health care providers, and the training of physicians are both going to be significantly and severely impacted to the point where access to health care becomes a problem. And so seniors--not just seniors, but all Americans--will have to begin to deal with the fact that primary care physicians, there won't be as many of them. There will be fewer doctors being trained, and for a number of reasons. The GMEs and the IMEs going to hospitals, if there is any reimbursement reductions to those, but also the fact that as a physician goes through all those years of training and he goes through 4 years of college, 4 years of medical school, an internship, 3 years of a residency, and then if he's a fellow because he wants to specialize, all of those years, and then they go into practice. And you see what the Affordable Care Act, you see what all these assaults are doing on our Medicare and Medicaid reimbursements to physicians as well as our hospitals. Hospitals that are primarily teaching hospitals face an additional challenge that could threaten the stability of their institutions. Hospitals that have residents in an approved graduate medical education--again, that GME program--receive an additional payment for a Medicare discharge to reflect the higher cost of care. Because they are a teaching hospital, their cost of care is higher. The regulations regarding the calculation of this additional payment--and I talked about this earlier--is the indirect medical education. This is all very complicated, but what I want to say and what I want to make clear, Mr. Speaker, is that if these cuts go through, it has been estimated that it will cost GME and IME reimbursements from Medicare $60 billion. This could mean a loss of 2,600 jobs and $653 million in State and local revenue. And, Mr. Speaker, a $10.9 billion loss to the U.S. economy. At current graduation and training rates, the Association of American Medical Colleges projects that the Nation could face a shortage of as many as 150,000 doctors in the next 15 years--150,000 doctors. We talked about this, and I think whether you're on one side of the aisle or the other, whether you agree with the health care law, we all agree that we want to have, in a country as rich and as generous as ours, we want to have access to health care for all Americans. But if we don't have physicians to provide that care--and this estimate is 150,000 doctors in the next 15 years--a shortage of that many, it will discourage this access to health care and will result in the longer waiting times for patients. Mr. Speaker, in closing, I want to just emphasize a few points this evening. And it's always an honor to be here on the House floor. It's always an honor to talk to the Speaker. And tonight it's been an honor to be able to address health care. As a health care professional, I spent years as a nurse and then, as I mentioned, as an attorney representing a hospital. I know that people within the health care profession are dedicated. They have a passion to provide the American people, to provide any people with quality health care, to make sure and ensure that they have quality health care. Mr. Speaker, the United States of America has the best health care in the world, and so it is so imperative that we preserve this health care system. My colleague from North Carolina mentioned earlier that we voted to repeal the health care law, the Affordable Care Act, because it's not in the best interest of good health care. And tonight you heard, Mr. Speaker, from several of my colleagues who are health care professionals who dedicated their whole lives to providing medical services to the people in their communities. They care about quality health care. They care about people, and they care that the United States of America has a good health care system. But we don't believe that good health care, access to health care, reasonable costs within health care, are going to result from the Affordable Care Act. The Affordable Care Act, I want to emphasize this one more time, Mr. Speaker, cuts Medicare to our seniors by $500 billion. To our seniors, that will be a devastating blow to the services and the access to services that you will have. But beyond that, it affects how our hospitals can provide care, how our hospitals will be paid, how our doctors and our young doctors will be trained for future generations. This Affordable Care Act may have been the most well-intentioned law, but it is devastating for health care and health care delivery services in the United States of America. Mr. Speaker, hospitals serve us and our communities. The crafting of the Affordable Care Act was carried out with the good intentions of many, as I said. I don't want to indicate or imply that people didn't have good intentions with this Affordable Care Act, but they approached it from the wrong direction. They put the government in the middle of a physician and the patient, and that can never work. But good intentions are not enough to excuse legislation which has a terrible and far-reaching, albeit unintended, consequence for all sectors of our society, especially our patients, our doctors, and our hospitals. Mr. Speaker, I yield back the balance of my time.

Ms. BUERKLE

Ms. BUERKLE. Mr. Speaker, I rise today to honor the life of Brigadier General Curtis J. Irwin, who, at the age of 88, passed away peacefully at his home in North Syracuse, New York on Wednesday, October 5th, 2011. Brigadier General Irwin was born in Syracuse on November 4th, 1922, to the late Joseph A. and Violet M. Irwin. He was preceded in death by his wife, Natalie J. Irwin ``Noble Nanny'' and his sister, Marilyn J. Irwin Boison. A combat veteran of WWII, he served as commander of the 174th Fighter Wing, (formally the 174th Fighter Group) New York Air National Guard at Hancock Field from January 1st, 1958 until March 13th, 1977. He retired from the New York Air National Guard on August 31st, 1978. General Irwin's flying career spanned more than 35 years, beginning when he was still attending North Syracuse High School. Working weekends at the old Amboy Airport, he received compensation for his labor in flight instruction. He began his military service in August of 1942 and entered pilot training the following March. After winning his wings and commissioning as a Second Lieutenant in the Army Air Corps in May of 1944, he served in the Pacific Theatre of Operations as a fighter pilot flying the P-47 Thunderbolt. Campaigns in which he participated include the China Offensive, Western Pacific, and the Air Offensive of Japan and the Ryukyus Islands. He was decorated with the Air Medal, the Oak Leaf Cluster, and four battle stars for his wartime service. Following World War II, General Irwin was an original member and assisted in the organization of the Air National Guard in Syracuse. While commander of the 174th Fighter Wing, General Irwin saw the unit undergo many aircraft conversions and unit changes. It was the first unit to operate jet aircraft in New York State and in 1951, was selected as one of the two units in the country to test a secret program of runway alert to augment the Air Force. The results were so successful that this program is to this day a vital part of the United States' air defense. In 1960, the 174th was recognized by the National Guard Bureau as the most combat-ready F-86 unit in the country. During the Berlin Crisis in 1961, the 174th was activated and within 30 days, all personnel, planes, and equipment were deployed to Phalsbourg Air Base in France. This was the largest movement of jet fighter aircraft in Europe since World War II. General Irwin led his unit's planes and crews across the northern Atlantic route via Labrador, Greenland, Iceland, Scotland, and on to the mainland of Europe. Despite many dramatic moments, all arrived safely on the continent. The unit was again called up during the Pueblo Crisis and was deployed to Cannon Air Force Base in New Mexico. In addition to his military service, General Irwin was instrumental in linking the 174th Fighter Wing with the local community. He organized a program of community education for planning and zoning actions compatible with aviation growth. Honors bestowed upon General Irwin are many. General Irwin was awarded the Governor's Trophy in 1960, 1973, and 1976. In addition, he received the first Department of Defense Award for Domestic Action in 1971. Thompson Road through Hancock Air Base now bears his name and is called the ``General Curtis Irwin Parkway''. In our local community, General Irwin was named to the North Syracuse School District Wall of Distinction in 1990. Surviving General Irwin are his children, Laurinda ``Laurie'' A. Irwin of Cottage Grove, Minnesota; Sheila M. (Lester) Austin of Lafayette, New York; Lisette ``Lisa'' Damon of North Syracuse; several nieces and nephews; his longtime companion Betty Tryon of Liverpool; and his 174th Fighter Wing Family. On behalf of the people of the 25th District of New York and a grateful Nation, I thank General Irwin for his service.

Ms. BUERKLE

Ms. BUERKLE. Thank you very much. Mr. Speaker, I am so proud to stand here this evening with my fellow Republican female Members of Congress, and we stand here tonight united on behalf of our seniors. I come before the House tonight, Mr. Speaker, not only as a nurse and someone who's been involved in health care most of my professional life; but I come here as the daughter of a 90-year-old senior citizen. I rise here tonight to express my appreciation to my mother and to all the other seniors who've made such valuable contributions, both in my district and throughout the United States of America. The seniors of today have fought wars, they've educated us, they've helped to build infrastructure and technology that has led the way to our modern life. Today's seniors are still busy enriching our society. Some of our seniors are busy in the community with care giving, with volunteering, with sharing important life lessons with their children, with their grandchildren and with their neighbors. Yet some seniors, Mr. Speaker, in today's economy find themselves working later in life; and when they finally have the ability to retire, they will be dependent on Social Security and Medicare, programs that they have paid into their entire lives. Mr. Speaker, America must honor its obligations to our seniors. We must achieve bipartisan solutions that don't cut our seniors' benefits but, rather, ensure continued existence of these programs. I'm so saddened by the calls I get from seniors day in and day out, Mr. Speaker. They call my office, they write letters, and they're so fearful because of the misinformation that they have been given. I want to stand here tonight with my Republican colleagues and ensure our senior citizens we are protecting your back. We are protecting Medicare and Social Security, the programs that you rely on. We want to assure them they don't have to worry, that we will take care of them. We will honor our commitment to them, just as they honored their commitment to the United States of America. I thank the gentlewoman from Missouri.

Ms. BUERKLE

Ms. BUERKLE. Mr. Speaker, I rise on this occasion to speak about one of the most significant issues facing us today: domestic violence. Mr. Speaker, domestic violence is both unacceptable and intolerable. As a legal domestic violence counselor, I have had the opportunity to offer pro bono legal services through Vera House in Syracuse, New York to help victims of domestic abuse and sexual assault. Vera House provides services for women, children and men, as well as domestic violence prevention programs for the Central New York region. Through my work at Vera House, I have seen how domestic abuse affects people of all ages, races, religions, socio-economic conditions. Domestic violence is known by many titles: domestic abuse, spousal abuse, family violence, and intimate partner violence. It also takes many forms from physical violence involving such things as hitting, kicking, biting, shoving, or restraining. It can be emotional or verbal abuse which manifests in many types of behavior--controlling, domineering, threatening, or humiliating. Mr. Speaker, domestic violence is a problem facing every community in America. According to the Centers for Disease Control, domestic violence is a public health problem affecting over 32 million Americans, or 10 percent of the population. The effects of domestic abuse are staggering. Physical abuse can be bruises, broken bones, head injuries, lacerations. But those are just the external physical wounds. Internal bleeding and chronic health conditions such as arthritis, irritable bowel syndrome, ulcers, migraines, and miscarriages can also be linked to physical abuse in abuse victims. Not only is domestic abuse physically dangerous, it also takes a psychological toll. The damage from this kind of abuse is not limited solely to survivors. It extends to their children, family, and community. All Americans have a moral obligation to stand up against those who commit violence against women, men, and children. We must be able to both recognize and prevent domestic abuse. We must come together to support survivors of abuse, while providing alternatives to this destructive cycle. As a country, we are equal to the task of fighting domestic abuse and sexual assault if we put our minds and spirits to it.

Ms. BUERKLE

Ms. BUERKLE. Madam Speaker, on rollcall No. 803, had I been present, I would have voted ``yea.''

Ms. BUERKLE

Ms. BUERKLE. I thank the chairman. Madam Speaker, I rise in strong support of H.R. 2074, as amended, the Veterans Sexual Assault Prevention and Health Care Enhancement Act. H.R. 2074, as amended, includes several worthy legislative proposals brought forth by the Members from both sides reflecting the subcommittee's oversight and activities to date. This bill would create a safer Department of Veterans Affairs health care system, allow for greater flexibility in VA payments to State Veterans homes, break down barriers to care for veterans with traumatic brain injury, clarify access rights of service dogs on VA property, and expand an innovative therapeutic option for veterans struggling with post-traumatic stress. Section 2 of the bill would require the VA to develop a comprehensive policy on the prevention, monitoring, reporting, and tracking of sexual assaults and other safety instances at VA facilities. I, along with the chairman, introduced this measure in response to a disturbing report issued by the Government Accountability Office in early June of this year regarding the prevalence of sexual assaults and other safety instances on VA property and the very serious safety vulnerabilities, security problems, and oversight failures by VA leadership. Abusive behavior like the kind documented by GAO is unacceptable in any form, but for it to be found in what should be an environment of caring for our honored veterans is simply intolerable. As a registered nurse and domestic violence counselor, I am all too familiar with the corrosive and harmful effects sexual and physical violence can have on the lives of its victims. It is an experience I wish on no one, much less one of our Nation's heroes or hardworking medical professionals. Madam Speaker, it is critically important that we take every available step to protect the personal safety and well-being of our veterans who seek care through the VA and all of the hardworking employees who strive to provide that care on a daily basis. The provisions included in this bill would require VA to develop clear and comprehensive criteria with respect to the reporting of instances for both clinical and law enforcement personnel, a comprehensive policy on reporting and tracking, risk assessment tools, a mandatory safety awareness and preparedness training program for employees, appropriate physical security precautions, and a centralized and accountable oversight system. Madam Speaker, I'm confident that these requirements will resolve the many wrongs uncovered by the GAO and ensure that the VA health care system remains a safe haven of healing for our honored veterans. Madam Speaker, section 3 of the bill would allow for increased flexibility in establishing rates for reimbursement to State homes for nursing home care provided to veterans with a service-connected disability rated at 70 percent or greater, or in need of such care due to a service-connected condition. State veterans homes have a long history of providing high quality care to some of our Nation's most vulnerable veterans. By requiring the VA to enter into a contract or agreement separately with each State home based on the particular needs of that veteran, this bill would correct an unintended consequence in law that has negatively impacted certain State homes and, consequently, the veterans under their care. This proposal was spearheaded by my friend and colleague, the ranking member from Maine, Mr. Mike Michaud. I would like to thank him for his advocacy and his hard work in advancing this proposal and recognizing the great service that our State homes provide. Madam Speaker, section 4 of the bill would improve the provision of rehabilitative care to veterans with traumatic brain injury by including the goal of maximizing independence and improving behavioral and mental health functioning within individual rehabilitation and reintegration programs. It would also require that rehabilitative services be included within any comprehensive long-term care services for veterans with traumatic brain injury. Many concerns have been raised by veterans and veterans service organizations that current law is being inappropriately interpreted to limit rehabilitative care for veterans with TBI to only those services that restore function. Madam Speaker, it is vital that we ensure that the recovery process for our veterans, especially those facing a lifetime of cognitive and neurological impairment, is ongoing, unburdened by institutional barriers, and extends beyond a strictly medical model to include services that allow those struggling to advance functional gains and reintegrate successfully into their home communities. Madam Speaker, this provision was introduced by Mr. Tim Walz of Minnesota, a veteran and valuable member of our Subcommittee on Health, and I would like to extend my personal gratitude to him for his service and for this proposal. Section 5 of the bill would clarify the access rights of service dogs on VA property and in VA facilities. This provision, introduced by Mr. John Carter of Texas, would amend an outdated VA policy that has left some disabled veterans and service dogs they need to function out in the cold. Unlike guide dogs for visually impaired veterans, service dogs are not guaranteed entry at VA facilities under Federal law. Recognizing the immense therapeutic value service dogs can have in promoting functionality and independence for our veterans, this provision would require that service dogs do have access to VA facilities consistent with the same terms and conditions and subject to the same regulations as generally govern the admittance of guide dogs on VA property. Madam Speaker, section 6 of this bill would direct VA to carry out a 3-year pilot program to assess the effectiveness of addressing post- deployment mental health and post-traumatic stress disorder, PTSD symptoms, through service dog training therapy. This legislation would allow for the expansion of promising and successful service dog training therapy programs currently in use at the VA Medical Center in Palo Alto, California, and the National Intrepid Center of Excellence in Bethesda, Maryland. Veterans participating in these programs have demonstrated improved emotional regulation, social integration, sleep patterns, and a sense of purpose and personal safety. The prevalence, Madam Speaker, of post-deployment mental health issues and post-traumatic stress disorder is rising among our veteran population, with over 190,000 veterans of Iraq and Afghanistan having sought treatment in VA for post-traumatic stress disorder. Veterans who struggle with mental health issues need and deserve the very best we can provide in care and treatment. Providing them with every tool necessary to reintegrate healthfully back into their families and home communities and achieve maximum health and wellness is one of my and my subcommittee's top priorities. We must continue to explore new and innovative therapeutic options to alleviate the symptoms of post-traumatic stress; and I thank my friend and fellow New Yorker, Mr. Michael Grimm, for his previous service to our country in the Marine Corps and for his very strong commitment to moving this initiative forward to assist his fellow veterans. Finally, Madam Speaker, section 7 of the bill would eliminate the requirement for the VA to provide Congress with an annual report on staffing for nurses and nurse anesthetists. This cumbersome and costly report was enacted almost 11 years ago. It is estimated to cost approximately $113,000 per year to produce. The report's intended purpose was to keep Congress apprised of recruitment and retention issues facing certain nursing positions within the VA. However, following that, Congress enacted Public Law 107-135, the Veterans Affairs Health Care Programs Enhancement Act, which fundamentally strengthened VA's ability to recruit and retain qualified nursing professionals through additional employee benefits and incentives. Reporting requirements included in this law, as well as a variety of other ways and means in which Congress can obtain such data, render this report unnecessary. Further, for the last several years, the report has concluded that nurse staffing remain stable within the Veterans Affairs Department. Additionally, eliminating the burdensome reporting requirement does not in any way reduce other existing requirements for VA to gather information on nurse staffing facility leadership, ensuring that such data continues to be readily available to Congress and other stakeholders. Madam Speaker, it has been an honor for me to work with my colleagues in a truly bipartisan manner to move H.R. 2074, as amended, forward; and I would like to thank each of them, particularly Chairman Jeff Miller and Ranking Member Bob Filner, and Health Subcommittee ranking member, Mike Michaud, for their tireless support on behalf of our honored veterans. Madam Speaker, I urge all of my colleagues to join me in supporting this important legislation.

Ms. BUERKLE

Ms. BUERKLE. Mr. Speaker, it is with great sadness that I wish to inform the House of Representatives that on June 30, 2011, Marine Corporal Kyle Schneider of Phoenix, New York, in Onondaga County was killed by an improvised explosive device while serving in Helmand province, Afghanistan. Corporal Schneider was born in Syracuse and lived in Baldwinsville, New York, for most of his life. He was a graduate of Baker High School and attended Onondaga Community College for a year before enlisting in the Marine Corps in 2008. Corporal Schneider is survived by his parents, Richard and Lorie Schneider; a brother, Kevin; and his fiancee, Theresa Lynn Dodge of West Columbia, Texas. Corporal Schneider was a proud and valiant marine. But he was also a son, a brother, a grandson, a fiancee, friend, and comrade. He will be greatly missed, and no words will diminish the grief of those who knew and loved him. In his death, he has earned the thanks of a grateful Nation.

Ms. BUERKLE

Ms. BUERKLE. I thank the gentleman from Wisconsin for yielding me this time. Mr. Speaker, I rise in support of H.R. 2560, the Cut, Cap, and Balance Act. This legislation is strong medicine, Mr. Speaker, but it is what will cure what ails the American economy. For far too long, Washington has overspent, borrowed, and heaped debt upon our children and our future children. If we don't make a change with cut, cap, and balance now, the American Dream will go away; and our children and our grandchildren won't have the opportunities that this country has always offered. It's time for the Federal Government to get our spending under control; and this legislation, Mr. Speaker, is a good first step. It's a reasonable plan, far more than we've seen from the Senate or from the President. It is the only plan that will cut, cap, and balance, and do what we need to do for this economy. Mr. Speaker, Washington has a spending problem. It does not have a taxing problem. I would just remind the Speaker, in December, a Democratic-controlled House, a Democratic-controlled Senate, and a Democratic President passed a bill to extend the current tax rates because they knew what would happen if we raised taxes in an economy as sluggish and as poor as this one is right now. Raising taxes is the wrong thing to do for this economy and for this country. Mr. Speaker, most States have balanced budget amendments. It's time for the Federal Government to do the same. This massive spending- induced debt is crushing the American Dream. We must stand up for the American Dream and do what's right for America. I urge my colleagues to pass H.R. 2560, Cut, Cap, and Balance.

Ms. BUERKLE

Ms. BUERKLE. Mr. Chair, I rise in support of the Cole Amendment to H.R. 2219. Mr. Cole's amendment would restrict the use of funds for furnishing military equipment, military training or advice, and other military activities in Libya. The President has failed to properly consult Congress on the engagement of hostilities in Libya. The President is also in violation of the War Powers Resolution because of the continued military action past the 90 days allowed under the War Powers Resolution. The Administration's attempt to excuse the continued U.S. military actions in Libya by saying that the hostilities do not reach the threshold set by the War Powers Resolution is disingenuous. The power of the purse plays an important part in the U.S. government's system of checks and balances. This amendment today will prohibit the President from continuing to conduct military operations in Libya until he can justify the actions to the Congress. I strongly support the limitation of funding of current military activities with respect to Libya. The President should not have a blank check to conduct wars without the consultation and authorization of Congress.

Ms. BUERKLE

Ms. BUERKLE. First of all, let me thank my colleague from the State of Washington for hosting this very special and important Special Order. When the Obama administration took office, many Americans were so concerned that the administration was too inexperienced to know how to even govern this country; but we soon understood that they were too mistaken to learn and too arrogant to care. Americans continue to see the unveiling of various provisions of the President's health care bill, such as the creation of the Independent Payment Advisory Board to ration health care, a disastrous half trillion dollars in Medicare cuts for new benefits, the betrayal of our friendship with Israel, and the willful pursuit of Libyan ``kinetic action'' in opposition to the wishes of the American people and in defiance of the War Powers Act. We have been betrayed by the choices of the leaders we depended on to steer this ship safely through troubled waters. But I have hope, just like the other Republican women here tonight, that while we have to accept the Democrat leadership's choices for a time, nothing says we have to live with them. I am here in Congress because I have watched the American Dream become increasingly fragile, and I said to myself over a year ago that I would not sit this fight out. Mr. Speaker, this is a fight. This is a fight for the very United States we love so dearly. Both sets of my grandparents came here from Italy. They worked hard; they raised their families, and they gave back to their communities. My presence in Congress, really in so many respects, just like so many of my colleagues', embodies the American Dream. I am a registered nurse, an attorney, and for the last 13 years have represented a teaching hospital. I am the mother of six children and a grandmother of 11. Mr. Speaker, I am a proud Republican woman. We Republican women stand here tonight not as an anomaly; we represent millions of Republican women who say that we are not going to accept being marginalized because of our political party. We are real women. We are real Republicans. We are here to restore the American Dream.

Ms. BUERKLE

Ms. BUERKLE. Mr. Speaker, I rise today to call attention to the issue of elder abuse. Today is Elder Abuse Awareness Day. Hundreds of thousands of Americans each year are the victims of elder abuse. According to the National Center on Elder Abuse, this number could be as high as 1 to 2 million Americans. Elder abuse, Mr. Speaker, is a broad term for the victimization of seniors 65 years and older. There is no one picture of what elder abuse looks like. It can be physical abuse, neglect, sexual abuse, emotional abuse or exploitation. The perpetration of elder abuse also varies--spouses, partners, caregivers in nursing homes, even neighbors. Our older elder Americans are especially vulnerable to abuse, particularly those who suffer from dementia or other mental diseases. I find it unconscionable that the very people who fought for us in World War II and Korea, who nurtured us, who taught us, who built this society around us, would be victimized in the twilight of their lives. Our elderly citizens have given us so much, and they deserve our appreciation, our respect, and most importantly, our protection, not just for what they've contributed, Mr. Speaker, but for the ways they still enrich our society and enrich us as a people. This August my mother, Mr. Speaker, will turn 90 years old. Three years ago, when my father died, she was lost. She was particularly vulnerable. Fortunately for my mother, she has children, grandchildren and great-grandchildren to help her and to support her. But how many other Americans, elderly folks are out there who don't have that support system, Mr. Speaker? This is not a Democratic or a Republican issue. This is an American issue. Our seniors, our elderly, deserve our help. They deserve our protection. Please, as Americans, today is Elder Abuse Awareness Day. Let us be particularly aware of our most vulnerable, our elderly citizens.

Ms. BUERKLE

Ms. BUERKLE. Thank you very much. I think it's so important to have this conversation with the seniors. We want to preserve your relationship with your physician. There is nothing more sacred than that relationship. This IPAB panel will disrupt that. It will come right between you and your physician. It's so important that we get the facts out, that we have this conversation with seniors, that you understand that we are fighting to preserve Medicare, fighting to preserve Medicare as we know it, and Medicare and the patient-physician relationship. With that, I thank you for this opportunity.

Ms. BUERKLE. And I thank you. Thank you for this time. Mr. Speaker, I rise here tonight, along with my colleagues and other members of the Doctors Caucus, with such concern about what is being proposed in the health care bill and what is now law. I think we need to have a frank discussion with the seniors, Mr. Speaker, because of the demagoguing and the fearmongering that has gone on by proponents of this health care bill. The fact is this health care bill, Mr. Speaker, is law. If it goes on without being interfered with, Medicare as we know it will be decimated. Five hundred billion dollars in cuts. That's going to affect the seniors. That's the law, and that's what's in place right now. What we are proposing on the Republican side is that: it is a proposal. But it is a place to begin the discussion about how we are going to save Medicare. And we must say over and over again to our seniors this bill will not affect you if you are 55 years and older. You will retain the exact same benefits that you have now. But we as health care providers, we as those who went into health care as advocates because we care about people, we want to protect and preserve Medicare. That's what this proposal is that the Republicans put forth in the budget. I think, Mr. Speaker, the irony in all of this is those who pushed this health care bill, organizations who pushed it on seniors and said this is a great bill, and vote for this health care bill, they now have waivers from the health care bill. They now are saying, well, it's good for all of you folks, but it's not so good for us. That should raise red flags. So I am so pleased to be here tonight with my colleagues to be able to have this conversation with the seniors, Mr. Speaker. They need to know the truth. They need to know that we want to preserve Medicare. We want to make Medicare better for us, for our children, and their children. And that's what this is about. I thank you for this time.

Ms. BUERKLE

Ms. BUERKLE. Mr. Chair, I rise in opposition to the Chaffetz Amendment to H.R. 1540, the Defense Authorization Bill. The amendment, if passed, would require the immediate withdrawal of troops from Afghanistan with certain limited counterterrorism operations permitted to remain on the ground. I appreciate the motivation behind the amendment because I too question the wisdom of our continued presence in Afghanistan. We are engaged in a protracted war there, and unlike our operations in Iraq, have yet to see stability and a solid foundation for independence emerge from the sacrifice of our men and women serving in Operation Enduring Freedom. While I believe that it is time to commence a timely discussion regarding Afghanistan, I do not believe that this amendment to the defense bill is the answer. The amendment short circuits the process necessary for thoughtful action and does not regard seriously the impact of the unintended consequences of immediate withdrawal on the stability of the region. U.S. forces in Afghanistan have made great strides in the last 6 months. In light of the recent death of Osama Bin Laden, the U.S. military must have the opportunity to consider the ramifications of his death on our current Afghanistan strategy. We have a short window in which the intelligence gained in his death can be leveraged successfully. How successful further action can or will be is unclear. Al-Qaeda may be able to regroup and revitalize. Regardless, immediate withdrawal will bring neither clarity nor stability to a region in which the United States has offered its highest currency, the blood of our young men and women in uniform.

Ms. BUERKLE

Ms. BUERKLE. Madam Speaker, I rise in support of this bill, the bill to fund our troops. The last Congress failed to pass a budget, and that's why we're here. That's why we're debating these CRs. This continuing resolution is the right outcome, not only for the American people, but for our military. This isn't a Democratic or Republican issue, this is what's best for the American people, and most importantly what's best for our troops. Give them certainty, give them what they need to keep us safe and allow us to be here today with this debate.

Ms. BUERKLE

Ms. BUERKLE. Mr. Speaker, I rise today to honor the career of Senior Master Sergeant Joseph F. Gianetto II. Originally from Oswego, NY, Sergeant Gianetto enlisted in 1971 and subsequently has spent over 39\1/2\ years with United States Air Force and the New York Air National Guard. Sergeant Gianetto has been decorated with numerous medals, awards and service distinctions. It is my honor to recognize such a distinguished citizen and airman. Sergeant Gianetto began his military career in the Air Force on the delayed enlistment program in June 1971 and was called to active duty in October 1971. Upon completion of basic training at Lackland Air Force Base, Texas, in November 1971, Sergeant Gianetto began technical school training as an Aircraft Maintenance Specialist at Sheppard Air Force Base, Texas. In March 1972, he was assigned to 314th Tactical Airlift Wing, Organizational Maintenance Branch, Flight-line Maintenance, Little Rock Air Force Base, Arkansas, and began on-the-job training for his five-skill level on the C-130E Hercules aircraft. He remained in that position until May 1973. In May 1973, Sergeant Gianetto was reassigned to the 56th Special Operations Wing, Organizational Maintenance Squadron, Flight-line Branch, Nahkon Phanom Royal Thai Air Force Base, Thailand, in support of combat operations in Southeast Asia. While assigned with the 56th Organizational Maintenance Squadron he performed duties as Aircraft Crew Chief on the OV-10A Bronco aircraft and deployed to forward operating locations at Ubon Royal Thai Air Force Base, Takhli Royal Thai Air Force Base, and Korat Royal Thai Air Force Base. After completion of his tour of duty in Southeast Asia, Sergeant Gianetto was reassigned to 314th Tactical Airlift Wing, Field Maintenance Branch, Little Rock AFB, Arkansas, where he worked in the Repair and Reclamation Shop as an Aircraft Maintenance Technician performing heavy maintenance on the C-130E aircraft. He was subsequently reassigned to the 314th Headquarters Squadron as an Aircraft Job Controller coordinating the maintenance efforts on a fleet of over 100 C-130E Hercules aircraft. Sergeant Gianetto applied for a release from active duty under the Palace Chase Program. His release from active duty was granted in September 1979. He became a member of the 107th Fighter Interceptor Group, Organizational Maintenance Branch, Flight-line Maintenance, New York Air National Guard, Niagara Falls, New York, and was assigned as a Crew Chief on the RF-101 Voodoo aircraft. In January 1980, Sergeant Gianetto transferred to the 174th Fighter Wing, assigned to the 174th Maintenance Squadron as Crew Chief on the A-10A Thunderbolt aircraft, and subsequently held assignments in the 174th Maintenance Operations Flight, and the 174th Operations Group, supporting F-16C Fighting Falcon Maintenance Operations, and RC-26 Counterdrug Operations. The 174th Fighter Wing was called mobilized and called to active duty on 29 December 1990. On 2 January 1991, Sergeant Gianetto deployed to Al Kharj Air Base, Kingdom of Saudi Arabia, in support of Operation Desert Shield/Desert Storm during the Persian Gulf War. He returned from the Persian Gulf on 20 May 1991 and was released from active duty on 13 June 1991. He also served in Operation Northern Watch from 23 August to 16 September 1997, and Operation Southern Watch from 28 February to 8 April 2000 and again from 28 July to 28 August 2001, all in support of contingency operations against Iraq. After the September 11th terrorist attacks, he performed over 40 days of active duty supporting Combat Air Patrol sorties in support of Operation Noble Eagle. On 14 October 2003, Sergeant Gianetto volunteered for his forth Air Expeditionary Force deployment in Support of the Global War on Terrorism. He deployed to Al Udeid Air Base, Emirate of Qatar, and was attached to the 379th Expeditionary Maintenance Operations Squadron, from 17 October 2003 to 5 December 2003, in support of combat operations in Iraq and Afghanistan during Operation Enduring Freedom and Operation Iraqi Freedom. On 28 November 2006, Sergeant Gianetto was again called to active duty deployed to Balad Air Base, Iraq in support of Operation Iraqi Freedom, where he was assigned to the 332d Expeditionary Maintenance Group. While there he worked as a Senior Weapon Systems Controller and Shift Supervisor, coordinating maintenance operations for three different active duty and Air National Guard assigned aircraft supporting contingency operations throughout the Iraqi theater of operations. Sergeant Gianetto redeployed after 96 days in-theater and was released from active duty on 1 April 2007. Sergeant Gianetto had been employed as an Air National Guard Technician since June 1980, working as an A-10 Aircraft Mechanic; Aircraft Production Controller; Aircraft Production Control Supervisor; Aircraft Production Control Superintendent; and a Logistics Management Technician. He retired from his full-time technician position on 1 March 2008. Militarily, he was assigned as the NCOIC for the 174th Fighter Wing RC-26 Counterdrug office on 23 June 2008, and is a former Maintenance Squadron First Sergeant. He has over 39\1/2\ years combined service, eight years of active duty in the United States Air Force, and the remainder with the New York Air National Guard. During these times and throughout his career, Sergeant has displayed honorable character and service to the United States Air Force and 174th Fighter Wing, and our country. His military decorations include the Meritorious Service Medal; Air Force Commendation Medal, with one oak leaf cluster; and Air Force Achievement Medal; five oak leaf clusters. His military unit and achievement awards include the Joint Service Meritorious Unit Award; Meritorious Unit Award, with two oak leaf clusters; Air Force Outstanding Unit Award with Combat ``V'' device and nine oak leaf clusters; Air Force Good Conduct Medal, with one oak leaf cluster; Air Reserve Forces Meritorious Service Medal, with nine oak leaf clusters. His military campaign and service awards include the National Defense Service Medal, with two bronze service stars; Armed Forces Expeditionary Service Medal with one bronze service star; Viet Nam Service Medal with one bronze campaign star; Southwest Asia Service Medal, with three bronze campaign stars; Iraq Campaign Medal, with two bronze campaign stars; Global War on Terrorism Expeditionary Medal; Global War on Terrorism Service Medal; Military Outstanding Volunteer Service Medal, Humanitarian Service Medal; Air Force Overseas Service Ribbon, with two oak leaf clusters; Air Force Expeditionary Service Ribbon, with gold combat frame and two oak leaf clusters; Air Force Longevity Service Ribbon, with eight oak leaf clusters; Armed Forces Reserve Medal with gold hourglass device, mobilization ``M'' device, and numeral ``7''; Noncommissioned Officer Professional Military Education Ribbon, with two oak leaf clusters; Small Arms Expert Marksmanship Ribbon; and Air Force Training Ribbon. Sergeant Gianetto's Foreign Service awards include the Republic of Viet Nam Gallantry Cross with palm device; Republic of Viet Nam Campaign Medal with date bar; Kuwait Liberation Medal-Saudi Arabia; and the Kuwait Liberation Medal-Kuwait. Sergeant Gianetto also holds the following New York State awards and decorations: New York State Military Commendation Medal; New York State Long and Faithful Service Award, with one gold and one silver device; New York State Desert Storm Service Medal; New York State Defense of Liberty Medal; New York State Conspicuous Service Cross, with one silver device; New York State Conspicuous Service Star, with one gold and two silver devices; New York State Recruiting Medal; New York State Counterdrug Ribbon; New York State Exercise Support Ribbon, with three ``E'' devices; and the Medal for Humane Service to New York State; and the New York State Air Guard First Sergeant Ribbon. He is also the recipient of the Air National Guard Noncommissioned Officer Academy Graduate Association, Outstanding Graduate of the Year Award for 1995; the 1999 Veterans of Foreign Wars Post #5885, All-State Commanders Award; and the 174th Fighter Wing Senior Noncommissioned Officer of the Year Award for 2001. In May 2004, Sergeant Gianetto received the American Red Cross Veterans award. He was also named the 174th Fighter Wing Base Honor Guard Senior Noncommissioned Officer of the Year for 2005. His effective dates of promotion are: Airman--16 November 1971; Airman First Class--1 April 1972; Sergeant--1 November 1973; Staff Sergeant--1 November 1976; Technical Sergeant--1 October 1980; Master Sergeant--1 February 1986; Senior Master Sergeant--13 February 1990. Sergeant Gianetto is a Past Post Commander and ``Life'' of the Veterans of Foreign Wars, Quatrini-Dehm Post No. 5885, located in Oswego, New York. He is also member the American Legion, James Harvey Spire Post No. 787, Cicero, New York. He is a member of the Air Force Association; the Air Force Sergeants Association; the Enlisted Association of the National Guard of the United States; the Enlisted Association of the New York National Guard; and the 174th Alumni Association. He is a member of the Air National Guard Noncommissioned Officer Academy Graduates Association; and the American Veterans (AmVets). He is also an active member of the 174th Fighter Wing Base Honor Guard, and a member of Bugles Across America. Without question, Mr. Speaker, Sergeant Gianetto is a very special person. He willingly served his nation, exuding loyalty and pride. For his unrelenting service, Sergeant Gianetto can retire knowing he has earned such a status. I would like to wish him well in his retirement years, as he will now be able to spend more free time with his wife Dale, his three daughters, Christina Gianetto, Jennifer (Gianetto) Rowan, Brynn Leigh (Shattuck) Shamp, sons Ryan and Kegan Shattuck, and grandson Nehemiah Shamp. Sergeant Gianetto, thank you for all your years of hard work, dedication and service to our country.

Ms. BUERKLE

Ms. BUERKLE. Mr. Speaker, it is good to be here. I thank the distinguished gentleman, my colleague from Georgia. I am very honored to be here to speak about health care in the United States of America. As was said, I am a registered nurse. I have been a registered nurse since 1972, a time in our Nation's health history where the physician and the patient had a relationship, and the government had not injected itself into that relationship. And then after awhile, I went into law. And for the last 13 years, Mr. Speaker, I have been a health care attorney for a large teaching hospital in upstate New York, for the last 13 years. What we did in that hospital and in my role as an assistant attorney general, we look at money, money that was owed to the State of New York. So I had a very up close and personal look at the complexity of health care in our country today. I contend that this bill, this piece of legislation that does anything but reform health care, will only increase the complexity of health care in this country. It will only make it more complicated. It will once again put the government right in the middle of the patient- physician relationship. I contend that is not what the United States of America is about. We need to let the free market play here in our health care system. I have spoken in my district to many, many people. I have done all kinds of talks, but there is nothing more up close and personal and of great concern to me than the health care system in our country. It is an issue that affects every American in one way, shape or form. This health care bill does not improve the health care system in this country. I came to Washington with a wide range of goals as a freshman, as my colleague has mentioned, but nothing more important to me than repealing this health care bill; this 2,000-plus-page bill that does anything but reform health care. It adds to the complexity of an already complex system. It puts the government in places where it shouldn't be, and it doesn't protect that patient-physician relationship. Last week when I was in the district, I had my very first health care advisory council meeting. I spoke with a group of physicians, a group of health care providers, hospital administrators, and we had a conversation. I said to them: What are your concerns as health care providers? You are on the front line. What can we do down in Washington on health care to make the delivery system better and more affordable? They looked at me, and interestingly enough, all of the people on the front lines came up with different solutions because, as you can imagine, doctors and health care providers are good at diagnosing. The question is now about the solution. What are we going to do for health care in this country? We are here tonight to say this bill is the wrong bill for this country, but we are not willing to leave it go at that. We understand that true health care reform will include medical malpractice reform. We need tort reform in this country. We need to increase the use of health savings accounts. We need to make insurance portable so when a person loses their job, they don't necessarily lose their health care coverage. We need to allow for the purchase of health care across State lines. We need to put the patient back in the center of health care. And I contend that this health care bill does not do that. So as we sat around, I said to my group of health care advisors, I said to them, What is it that concerns you most regarding health care in this country? The first thing was our health care, this health care bill that was just passed. And when you get into why does it concern you, because it adds so many layers of bureaucracy and regulations to an already ladened bureaucracy, already an industry and system that is ladened with regulations. If you talk to a hospital or a physician, the regulations and the impediments they have to access that patient for health care are incredible. So the concern with this bill is it adds so many more layers. It takes this health care bill, and one of the biggest problems with this health care bill is that it takes a piece of legislation and it hands it off to the regulators. Then, with the regulators, they are left to interpret and to deal with and come up with regulations that affect our health care providers. Beyond that, they recognize the need for tort reform. We need medical malpractice liability reform. If we are going to talk about reducing the cost of health care, we must consider that. And then they talked about the increased regulations on the health care profession. What we all agreed upon in that meeting was that the health care in this country, it is a good health care system. We have good health care. The quality of health care is not the issue. The issue is the system of health care. And this bill that was passed in 2010 does nothing to make that health care system better. It only complicates it. It only ladens it with more regulations and once again puts the government back in between the physician and the patient relationship. I thank my colleague who has an esteemed history of being a medical provider in the health care industry. He understands these issues. He understands what good health care is and what a good health care system would look like. And so I commend him and thank him for this opportunity to speak. I think what we need to do in Washington is to repeal this health care bill. We need to put our heads together collectively and talk to the professionals, talk to the health care providers, talk to the patients, and get together and come up with a systemic plan that will reduce the cost of health care, help to improve access to health care, and not affect the quality of the wonderful health care that the United States of America offers. In my years in the attorney general's office representing a large teaching hospital, I know how many people wanted to come to this country for health care--I know people from Canada and from Europe-- because they knew they had access to good, quality care. They knew they wouldn't have a 6- or 9-month wait. I think with this system, if we allow it to go on, this health care bill, we will see those 6- and 9- month waits while patients are waiting for the government to make a decision about their health care access. So we need to repeal this bill. We need to enact true health care reform so we can improve access, we can reduce the cost of health care, and we can maintain the fine quality of health care in this system. I thank my colleague.

Ms. BUERKLE. Thank you. Mr. Speaker, my colleague just brought up the cost of this health care bill. I think it's interesting to talk about and insert what I have heard from the health care community throughout the course of this discussion. For many hospitals which have a high level of indigent patients, there is what is called a disproportionate share of money that is paid to those hospitals to help them offset the cost of treating folks who are on Medicaid and who are not able to afford their own health care coverage. This health care bill removes the disproportionate share. It phases out that payment to hospitals so that they can afford to treat indigent patients who cannot afford health care. I think that's a very significant piece of this bill--of this law--that was not discussed nor how it will impact and how it will hurt hospitals. I think, beyond that, we need to talk about seniors and the choices that this health care bill takes away from seniors--again, that wasn't discussed--which are the Medicare Advantage programs and all of the disadvantages that this bill will cause to seniors. We need to keep our health care system intact so those who need the system, such as the seniors, have access to good health care and so their coverage is not hurt. This bill does hurt the senior coverage.

Ms. BUERKLE

Ms. BUERKLE. Mr. Chair, I rise in strong support of the amendment offered by my colleague, Representative Miller of Michigan. It is important that the FAA work with other federal agencies, including the National Guard, to integrate Unmanned Aerial Systems into the National Airspace System. My district is the home of the 174th Attack Wing of the Air National Guard that uses Hancock Field in Syracuse. They use Unmanned Air Vehicles, UAVs, that currently must be transported to and from Fort Drum in order to perform their mission. It is important that the FAA integrate these UAVs into the National Airspace System as quickly and safely as possible. In addition to performing a critical mission for national security, the 174th is responsible for 1300 jobs in the Syracuse area. Finding a way to get the federal agencies to work together to allow UAVs to operate out of Hancock Field is important to the economy of this region. I strongly support this amendment and encourage the Chairman of the Transportation Committee to protect and strengthen this provision in conference.

Ms. BUERKLE

Ms. BUERKLE. Mr. Speaker, today I rise to speak about two of the most significant issues facing our society today--the twin scourges of domestic violence and sexual abuse. Our society has a moral obligation to stand up against those who exploit their power to commit violence against women, men, and children. I join other Members here today in taking the opportunity to discuss these issues and participate in the White Ribbon Campaign. On Tuesday of this past week, March 22, in Syracuse, New York, the president of SUNY Upstate Medical University, Dr. David Smith, chaired a breakfast. It was the kickoff to the White Ribbon Campaign, a campaign that is to draw attention to and focus on, raise awareness of, domestic violence and sexual abuse. The White Ribbon Campaign is an international campaign, participating probably across 55 countries. Later in the week, on Friday, again Dr. Smith led a group of men in a march raising awareness for domestic violence. They marched in women's shoes down the main street in Syracuse, New York. Again, ``walk a mile in their shoes,'' raising awareness, raising the consciousness of domestic violence and sexual abuse, these issues that face our society today. The international campaign has probably 55 countries and involves a general public education focused on preventing domestic violence. Many of my fellow Members this past week have been wearing white ribbons for our commitment to putting the spotlight on domestic violence. Wearing the white ribbon speaks to our personal pledge to never commit, condone, or remain silent about violence against women and children. The white ribbons were sponsored by Vera House. Vera House was formed in 1977 in Syracuse, New York, by Sister Mary Vera because Sister Mary Vera recognized the need for emergency shelters for women. She developed and expanded her services. Now, today, Vera House has merged with the Rape Crisis Center, and they serve the needs of so many women, men and children who have been abused. Again, the whole White Ribbon Campaign is to raise public awareness of domestic violence. At this time, I yield to the gentlewoman from North Carolina, Representative Renee Ellmers.

Ms. BUERKLE. I thank the gentlewoman from North Carolina for her kind comments and for putting attention on the Rape Crisis Centers and all of these centers which have dealt with this, because today, while we rise and we stand to call and bring to consciousness domestic violence, this is also a wonderful opportunity to thank the hundreds of thousands of people who volunteer in these shelters, who work for these agencies, who provide a safe haven for the women, the men and the children who are abused--for the victims of domestic violence. My colleague talked about what these centers do. Vera House, the agency that I stand today to represent and to talk about, has expanded their services these days to outreach, advocacy, education, and children's counseling. Children, as you heard from my colleague, are often the victims of domestic violence between spouses. They are the ones who suffer. Vera House offers counseling to these children. Most importantly, Vera House provides violence education for the perpetrators. If we are going to change behaviors, we have got to educate and to retrain the way the perpetrators think. General Leave

Ms. BUERKLE. Mr. Speaker, at this time, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and to include extraneous material on the subject of domestic violence and sexual assault.