Frank Pallone

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I yield 3 minutes to the gentleman from California (Mr. Garamendi).

Mr. PALLONE. Mr. Chairman, I yield myself 1 minute. I have heard Dr. Burgess talk about Governors. I just want to give you some quotes from some Governors--Republican Governors. Nathan Deal, a former member of the Energy and Commerce Committee, former chairman of the Health Subcommittee, this is what he said with regard to the State exchanges and the grants. He says: ``One of the real problems that some of us as Governors foresee is if the mandates on States remain in place, the funding from the Federal level to carry out those mandates is withheld. That's the worst possible condition that States could be left in.'' That is exactly what my colleague from Texas is proposing. The States will continue to have the mandate to set up the exchange or, without money and therefore not be able to tailor to exchange to the State or alternatively letting it go to the Federal Government, having the Federal Government run a Federal exchange. Nathan Deal, one of our own Members, chairman of the subcommittee, said, Worst possible scenario. I don't understand. Again, I keep saying the same thing, but I have to repeat it, Mr. Chairman. To say that we're going to have State exchanges without having the funding means the State exchange will either be lousy, or it simply won't exist and the Federal Government takes over. I yield now 2 minutes to the gentleman from Michigan (Mr. Levin), the ranking member on the Ways and Means Committee. (Mr. LEVIN asked and was given permission to revise and extend his remarks.)

Mr. PALLONE. Mr. Chairman, can I inquire how much time remains on both sides?

Mr. PALLONE. I yield myself 3 minutes. Mr. Chairman, this is just another in the Republican series of efforts to try to repeal the Affordable Care Act. I don't need to say, but I will say over and over again how effective the Affordable Care Act has been. We have already put in place most of the anti-discriminatory aspects of the Affordable Care Act so that people now can have their children up to 26 on their insurance policy. They don't have lifetime or annual limits on care. We've ended arbitrary rescissions. We're giving patients access to preventive services without cost. We've begun the process of filling up the doughnut hole by giving seniors a $250 rebate last year, and now a 50 percent discount on the drugs. The list goes on and on. People are starting to see the benefits of the Affordable Care Act. But as you know, over the next few years, until 2014, one of the major benefits of it is that we will now cover almost every American; 32 more million Americans that have no insurance now, with a guaranteed good benefits package, lower costs, and help in paying their premiums. The fact of the matter is, the Republicans want to eliminate all this. And when they talk today about bringing up a bill that would eliminate the grants or the funding for the state exchanges, this is at the core of the Affordable Care Act because, without effective state exchanges, robust state exchanges that are actually tailored, if you will, to individual States, it will be more difficult to do the things that I mentioned that are the commitment and the promise of the Affordable Care Act. Now, what I don't understand though is that my colleagues on the other side of the aisle have always been advocates for States' rights. The consequence of their legislation today if it were to become law would mean that States, and 49 States and most of the territories have asked for these grants, would be denied these grants to set up the State exchanges. Most likely, what will happen then is that, rather than have a State exchange which is tailored to their own State and their own constituents, they will end up having a Federal or national exchange. Now frankly, I don't have a problem with that. But if you're a States rights advocate, which is what a lot of the Republicans have been saying all along, why would you want to force the States to not have their own flexibility, not set up their own State exchanges and instead set up a Federal exchange? The exchanges aren't going to go away with this legislation. It's simply going to mean that the States can't do a good job, or that they're going to yield that power to the Federal Government and you're going to have a national exchange. This is the worst time to do this. As we know, States are hurting. They don't have money. Most of them have a crisis in terms of balancing their budget. Why would you want to deny them the money to set up the exchange? I'll give you an example in my own State. My own State has applied for some of these grants. They are using it to do demographics to find out what kind of people they have, what their health care needs are, so they can tailor the State exchange in a way that's most effective to cover the most Americans and provide them good quality health care at a low cost. That's what this is all about. And for the Republicans today to bring this bill up in their effort to try to repeal the whole package, it absolutely makes no sense whatsoever. I just don't understand it. They talk about mandatory funding. Well, we have mandatory funding for Medicare, for Medicaid, for all kind of things in this Congress. All they're going to do with this is make it more difficult for the States to establish their own exchange. I reserve the balance of my time.

Mr. PALLONE. I yield now 2 minutes to the gentleman from Texas (Mr. Green).

Mr. PALLONE. Mr. Chairman, I yield myself 30 seconds. Again, I don't understand what Dr. Burgess is trying to say, the point he is trying to make. If we don't have this funding under this bill, States are not going to be able to choose the type of marketplace that is best for their families and businesses. By passing this bill, you take away ultimately the States' right to make the decisions about what kind of plans they have and how they want to tailor these plans. All he is doing with this bill is handing it over to the Federal Government, exactly the opposite of what he is saying. What he is reading is essentially what is going to happen if there is no State exchange and there is a Federal exchange. So why deny the States the money, when they can tailor the exchange with those grants? I yield now 2 minutes to the gentlewoman from Connecticut (Ms. DeLauro), the ranking member on the Labor-HHS appropriations subcommittee.

Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume. My colleague on the other side, I don't understand. You are saying that you want Austin to do it, you want Austin to have the flexibility to frame a program that is done best because you think that Austin and the State are going to do it best. Well, if that is the case, why in the world are you putting this bill on the floor? Because my whole point in this amendment is that, by passing this bill, you are simply abdicating the right of the State to make a decision and to have the flexibility to set up a good program that is tailored to the State. It is the exact opposite of what you are saying you want to do. If you believe that the Secretary of Health and Human Services in Washington is going to make the wrong decision, I don't think she would, but if you believe that, then you shouldn't be offering this bill, because this bill takes away the flexibility and the power of Austin or the States to make the right decisions. It is totally contrary to the purpose of what you are trying to accomplish. To me, it is mind-boggling. Now, I think what you are really trying to do, of course, is just say let's forget about the exchanges, let's defund the exchanges, let's get rid of the whole Affordable Care Act. Obviously, that would be very unfortunate because so many more people are going to be covered at a low cost with a good benefit package and all the benefits and the antidiscriminatory practices that have already been in place would be gotten rid of. I would say again, if you are totally opposed to the bill, that is one thing. But if you feel strongly that the State exchanges should be run by the States, then your legislation today is totally misplaced.

Mr. PALLONE. I yield myself an additional 30 seconds, Mr. Chairman. Governor Herbert of Utah stated at a recent hearing in the Energy and Commerce Committee on March 1--and he was commenting on Governor Barbour, who also appeared before the committee--he said: I am not saying it is the approach. It is an approach. And I would just echo what Governor Barbour said. You know, all States ought to have the opportunities to find the solutions to the problem. So again, even the Governor of Utah, which Dr. Burgess has mentioned many times, has said: I may not like the Affordable Care Act; I may not even like exchanges. But if you are going to have exchanges, it certainly makes sense for States to operate them and have the money to do it in a right way. That is what this bill would stop. That is why we need the GAO report.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, how much time is left?

Mr. PALLONE. Mr. Chairman, I yield myself 30 seconds. I have listened to my colleague from Georgia (Mr. Kingston), and I can't believe he is blaming the deficit on President Obama. We had 8 years and two wars under Bush, all of the giveaways to millionaires and the special interests, and now, all of a sudden, it's Obama who is responsible for the deficit. We are talking about $50 million a year for probably some of the best schools you could ever imagine with these school-based clinics, and the gentleman is talking about the deficit. I yield 2 minutes to the gentleman from California (Mr. Miller).

Mr. PALLONE. I yield myself the remainder of my time. Mr. Chairman, I have said over and over again, I don't understand what the Republicans are up to today. They keep saying that they want to repeal the Affordable Care Act, the health care reform. They keep bringing bills to the floor on a regular basis that would either in a piecemeal or in a large fashion repeal the Affordable Care Act. But the arguments make less and less sense every day as they start to take the pieces of the legislation that they even agree with themselves. Today, we have been here for many hours. My colleague from Texas and others said that they support school-based clinics. They even went so far to say they wouldn't even have a problem with the Federal Government paying for it. Support the Federal dollar. Support the concept. Agree that it is a preventative measure. Then they went on to say that maybe we shouldn't pay for construction; we should only pay for operations. Well, the fact of the matter is that when you submit an application for construction or renovation of the clinic, under this law you have to show that you have the money to operate, and it is pretty clear that if you don't have the building, you are not going to be able to operate. So, again, I don't understand what they are trying to accomplish here. We all know that these centers make sense. They bring kids who would otherwise not see a doctor to have that opportunity. I thought my colleague from Virginia (Mr. Moran) really brought home the point when he said that a lot of kids don't even participate in athletics unless they have a school-based clinic because they have to be certified that they are healthy in order to participate in athletics in the school. Well, doesn't that make sense, because then they don't sit around and become obese. They actually exercise. They participate in team sports. They get to the whole collegiality of being involved in a team sport and the exercise and the health benefits of that. This is a win-win situation. I wish you had picked something else today to bring to this floor to repeal, because this is the worst thing you could have brought to the floor. No one, including yourself, argues that these school-based centers are not valuable, so stop trying to cut them. Stop trying to come up with some fantasy about how you are going to fund some part of it and not fund the other part of it. It is a good thing. It is probably one of the best things we have in this legislation, the Affordable Care Act. I think it is not rational and makes no common sense to pick this out as something to spend two or three hours on to say that this is something we shouldn't do. We should do it. Oppose this legislation.

Mr. PALLONE. I will yield myself 2 of the 4 minutes and go back and forth with Dr. Burgess here. The fact of the matter is that the Congress uses the CBO as the official statement, if you will, of our budget and the cost of legislation. That is what we have all agreed on a bipartisan basis we are going to use. I don't always agree with CBO. You have heard me many times say that they don't score prevention enough. The fact of the matter is that is what we are going to use. We have all agreed. And the CBO says that the Affordable Care Act saves over $1 trillion over the life of the bill. Everyone knows, and I know that Dr. Burgess, even himself, believes in preventative care. That is what these school-based health clinics are all about. They work. They get kids into the clinic or the center, they get primary care. They prevent having to go to an emergency room, to a hospital, or any other kind of institutionalization. This is what we are trying to do with the Affordable Care Act. We are trying to save money by guaranteeing people get to see a doctor when they need one so they don't get sick. It is all about wellness. That is what it is about. And wellness saves money. The Federal Government doesn't have to spend the money when the person goes to the emergency room and doesn't have any insurance coverage. It is that simple. I have had this argument many times with Dr. Burgess. I think that, for the most part, he agrees with me, and he has even said today that he thinks the school-based centers are a good thing. So I really don't understand the basis of this legislation that is being proposed this evening, and I certainly would urge my colleagues to vote against it. I reserve the balance of my time.

Mr. PALLONE. Mr. Chairman, I have no further requests for time, and I reserve the balance of my time.

Mr. PALLONE. Mr. Chairman, I yield myself 30 seconds. From the very beginning today, Dr. Burgess, I have said, and many of us have said, the Affordable Care Act saves money and that school-based centers save money. The CBO estimates over $1 trillion in savings from the Affordable Care Act; $30.40 less than Medicaid costs for a kid that goes to a school-based clinic. By repealing this funding for school- based clinics, you are going to cost the Federal Government more money. So don't talk to us about the deficit. We save money with our legislation, and you are spending more money by proposing this bill. I yield 2 minutes now to my colleague from New Jersey (Mr. Andrews). (Mr. ANDREWS asked and was given permission to revise and extend his remarks.)

Mr. PALLONE. Mr. Chairman, can I inquire of the time on both sides?

Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentlewoman from California (Mrs. Capps) who is probably the most knowledgeable person in this House on this subject of school-based care.

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

Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentleman from Connecticut (Mr. Courtney).

Mr. PALLONE. I yield myself such time as I may consume. Mr. Chairman, again, Dr. Burgess talks about how we're spending money on construction, renovation, but we don't provide mandatory spending for operations. As I said, in order to get the grant under the Affordable Care Act for construction of a school-based health center, you have to show that you have the money to operate. So what does that mean? That means that we are using some Federal dollars to attract either State or in many cases private dollars to set up these centers. What is wrong with that? They are guaranteed that once the money is spent on construction and creating the jobs that come from the construction or renovation that the money is available to operate the centers. There's nothing wrong with that. It's actually a good thing. It promotes a Federal-State cooperation, and it brings in some private dollars as well. The other thing I would point out is my colleague from Texas keeps talking about mandatory appropriations. The fact of the matter is that health care initiatives over the years, Democrat and Republican, have provided some mandatory, some discretionary. The same thing we're doing here. The fact of the matter is that Medicare, Medicaid, and a lot of other Federal health programs pay for health care services with mandatory expenditures. And a lot of that is for acute care, acute illness, injury, or chronic diseases. Now, there's no similar approach when it comes to promoting wellness, preventing disease, and protecting against health emergencies. So here for the first time now we're going to have a combination of some mandatory and some discretionary spending for a preventative program, a clinic, a center for kids in their schools that actually helps and prevents them from going to a hospital, to an emergency room, to be institutionalized. So I just think this is false, this notion of mandatory versus discretionary. The bottom line is if you care about school-based centers and you want to have them, then I think you should oppose this bill because the legislation that this bill is seeking to kill, the Affordable Care Act, for the first time provides funding to put up a lot of these school- based centers. And this is what we need as a preventative measure to prevent these kids from having more serious problems, going to the emergency room. Let's give them primary care up front so they can stay well. I reserve the balance of my time.

Mr. PALLONE. I yield myself 3 minutes. Mr. Chairman, once again I'm listening to my colleague Dr. Burgess, whom I respect, and he's talking about the common sense being lacking on the Democratic side. After listening to him, I think the rationale and the common sense is lacking on the Republican side. My colleague from Texas has said over and over again he supports school-based clinics. He even supports Federal funding for school-based clinics. Then what is the possible rationale for posting this bill? Many of my colleagues on the other side have said today they're opposed to the entire Affordable Care Act. They're opposed to funding the entire Affordable Care Act. Yet somehow today they're taking little pieces of the Affordable Care Act that they even agree with, from my understanding in listening to my colleague from Texas, and still saying we're going to defund them. I defy my colleague to really understand why. School-based health clinics are a tremendous success story. These programs provide primary care, mental health, dental health services to vulnerable children across the country in every State. Multiple studies have found that these programs are cost-effective investments. They result in lower emergency room usage, hospitalizations, and Medicaid costs. In fact, patients seen at school-based health centers cost Medicaid on average $30.40 less than comparable non-school-based health center patients. This is saving the Federal Government money. That's the bottom line. And what we're trying to do here is to basically provide for construction, renovation, and equipment for these centers. Now, in order to get the grant for that, you have to show that you have the funds to operate the center. So when Dr. Burgess says, why are you paying for construction, why are you paying for renovation, but you're not paying or you're not providing for operations? Every one of these has to show that they have the money to do the operations before they get the money for construction. What does construction and renovation mean? It means jobs. I repeat again, when I was home for the last 2 weeks, all I heard from my constituents is, When are you going to improve the economy more? When are you going to create more jobs? This is a program that creates jobs, helps kids, provides for their well-being and their health, and it's all preventative. These projects have to be shovel ready in order to be funded. So we're talking about money that's going to be immediately spent to put these centers together and to renovate them. I keep hearing my colleagues say repeal and replace. That's the mantra with the health care bill: We want to repeal it and replace it. But I never hear anything about replace. All I hear about is repeal, and in this case repealing a program that is a proven success. It makes absolutely no sense to pass this bill. I hear my colleagues on the other side say over and over again they're for these clinics, they're for these centers. Then why in the world do you bring this bill to the floor? I urge my colleagues to oppose this legislation. I reserve the balance of my time.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I demand a recorded vote.

Mr. PALLONE. Mr. Chairman, I move to strike the last word.

Mr. PALLONE. Thank you, Mr. Chairman. This amendment provides for a GAO study to determine school districts most in need of constructing or renovating school-based health centers. Basically, it asks the Controller--or I should say mandates the Controller--to conduct a study to determine the school districts most in need of construction and renovation, and not later than 1 year after the date of the enactment, the Controller has to submit to the Congress a report setting forth the results and conclusions of the study under this subsection. Mr. Chairman, I know we've had a lot of debate today about money, but the fact of the matter is that the $50 million per year doesn't actually cover the costs of all of the schools that have requested and applied for construction or renovation funds. That's why I would like to have this amendment passed and hopefully accepted by the other side so that we can find out exactly how many more of these clinics, or centers, are in need of funding. I yield back the balance of my time.

Mr. PALLONE. I yield back the balance of my time.

Mr. PALLONE. Mr. Chairman, I have an amendment preprinted in the Record as amendment No. 2 to H.R. 1214, as the designee of Representative Capps.