Henry Waxman

Mr. WAXMAN

Mr. WAXMAN. Madam Speaker. I rise in strong support of H.R. 5327, a bill authorizing critical funding to ensure Israel's security. Ever since President Kennedy first approved the sale of Hawk missiles to Israel in 1962, U.S.-Israel cooperation on defensive missile systems has developed into a productive strategic partnership that safeguards the security of our ally Israel while advancing our own military edge. Iron Dome, the program supported by this bill, is a system of anti- missile batteries capable of intercepting the short- and medium-range Qassam, Katyusha, and Grad rockets that have been used by Hamas and Hezbollah to terrorize Northern and Southern Israel. The successful testing of the first two operational batteries earlier this year demonstrated the system's ability to revolutionize Israel's ability to defend against these attacks. The bill before us authorizes $205 million for Israel to build and deploy 10 more mobile batteries that will be available for rapid deployment wherever and whenever needed. And it is important to note that our own military stands to benefit from the advanced radar and other technologies that are components of this system. During its 34-day war with Israel in 2006, the Iranian-backed Hezbollah movement unleashed nearly 4,000 rockets against Northern Israel. In the 5 years following Israel's complete withdrawal from Gaza in 2005, Hamas has unleashed 6,000 rockets on Southern Israel. Until now, Israel has had no defenses against such weapons. The Obama administration deserves tremendous credit for this initiative and its hands-on efforts to advance Israel's defensive capability at a critical time. It is no secret that Hezbollah and Hamas are rebuilding their arsenals. Hezbollah is believed to have rearmed with some 45,000 rockets and missiles, including Scud missiles and other weapons that can hit Tel Aviv or Jerusalem. Iran continues smuggling weapons material to Hamas via Egypt. It is also no secret that Iran has in the past used its terrorist proxies in Lebanon and Gaza to provoke Israel and divert international attention from its nuclear program and its defiance of international law. The 2006 Lebanon war, which was precipitated by Hezbollah's kidnapping of three Israeli soldiers, happened just as the IAEA was recommending that the United Nations demand that Iran suspend all enrichment-related and reprocessing activities. This investment to upgrade Israel's security is essential as the administration and Congress intensify efforts to pressure Iran with sanctions. I urge my colleagues to support this measure. I look forward to the full deployment of Iron Dome, and I hope that the region moves toward a peaceful future that will obviate its need.

Mr. WAXMAN

Mr. WAXMAN. Madam Chair, I rise in strong support of H.R. 5019, the Home Star Energy Retrofit Act of 2010. This legislation, more than anything, is about jobs. When enacted and funded, Home Star will create 168,000 new jobs here in the United States. These are jobs that won't be outsourced overseas. They are construction jobs in our neighborhoods and our communities. And they're manufacturing jobs for workers at factories in America. Nearly one in four workers in the home construction and services industry has been laid off. Passing Home Star says, ``Help is on the way.'' Home Star would accomplish this by establishing a rebate program for the installation of energy-efficient home upgrades. These rebates would encourage homeowners to hire contractors to install new, efficient heating and air conditioning, to insulate their homes, and to replace drafty windows and doors. It's an approach that can benefit every contractor in this country, from small independent businesses to contractors associated with large home improvement store chains. This legislation also saves consumers money, and it cuts pollution. When it is fully funded, Home Star will allow 3 million families to retrofit their homes to be more energy efficient. Homes in America account for over 20 percent of the Nation's carbon pollution. Existing technologies and practices can cut home energy use by up to 40 percent. That would slash carbon pollution by millions of tons. This is a bipartisan bill. It was introduced by Representatives Welch and Ehlers. The legislation was reported favorably from the Energy and Commerce Committee last month in a bipartisan vote of 30-17. Representative Welch and Subcommittee Chairman Markey deserve special recognition for their hard work in pushing this legislation to become a reality. The bill also has support from a remarkably broad coalition that ranges from local contractors to environmentalists to organizations like the National Association of Manufacturers and the Chamber of Commerce. These groups all support Home Star because it's a commonsense program that's good for the country. One question that was raised when the rule was being debated is whether this will affect our deficit. This is a complete red herring. The legislation we are considering today is an authorization. It does not spend a dollar of taxpayers' funds. That's why the nonpartisan CBO says enacting this bill would not affect direct spending of revenues. Once we have passed this legislation, we will need to pass another bill that provides the funds to carry it out. We will do that in a fiscally responsible way. I urge Members to vote for jobs, for consumers, and for the environment. Committee on Oversight and Government Reform, Washington, DC, May 4, 2010. Hon. Henry Waxman, Chairman, Committee on Energy and Commerce, Washington, DC. Dear Chairman Waxman: I am writing to confirm our mutual understanding with respect to the consideration of H.R. 5019, the Home Star Energy Retrofit Act of 2010. I appreciate your efforts to consult with the Committee on Oversight and Government Reform regarding those provisions of H.R. 5019 that fall within the Oversight Committee's jurisdiction, including provisions related to the federal civil service and acquisition policy. Given the importance of moving this bill forward promptly, I do not intend to object to its consideration in the House. However, I do so only with the understanding that this procedure should not be construed to prejudice this Committee's jurisdictional interest or prerogatives in the subject matter of H.R. 5019, or any other similar legislation. I would also request your support for the appointment of conferees from the Oversight Committee should H.R. 5019 or a similar Senate bill be considered in conference with the Senate. Finally, I request that you include our exchange of letters on this matter in the Congressional Record during consideration of this legislation on the House floor. Sincerely, Edolphus Towns, Chairman.

Mr. WAXMAN. Mr. Speaker and my colleagues, this bill is modeled on a law that worked. We called it the Cash for Clunkers bill. It encouraged people to buy cars. It produced more jobs. It produced energy efficiency as newer cars that were purchased were less polluting than the older ones. And the bill we have before us is one that is strongly supported by a coalition of the National Association of Manufacturers, the environmentalists and the Chamber of Commerce. So what does this motion to recommit do? It undermines the basic structure of the bill. It eliminates the rebates to contractors. It eliminates the loan program. It eliminates the public education campaign. It creates burdensome procedures for consumers to claim rebates, and it creates burdensome income thresholds as well. We have worked hand in hand with the contractors, the NAM, the Chamber, and others to craft this bill. This motion to recommit is a good thing to vote for if you are against the bill; but otherwise, it is filled with a lot of gimmicks. For example, it says no funds provided under this title shall be used for the purposes of conducting travel to gambling or gaming establishments in connection with official duties related to the title. What is that all about? It was just thrown in. It was never an issue that was raised in committee, in hearings. It was just thrown in there. If you believe that this bill makes sense because it will provide employment to construction workers, it will make homes more energy efficient, it will save families billions of dollars on their energy bill, if you think that is important, because the construction industry has the highest unemployment rate of any sector in the Nation, one in four are unemployed, stand with the Chamber, the NAM, your local hardware stores, your carpenters, your local contractors and businesses, and vote against this motion to recommit and vote for final passage. Mr. Speaker, I would now like to yield to the gentleman from Vermont, the author of the legislation.

Mr. WAXMAN. I'm sorry. I do not have extra time.

Mr. WAXMAN. I object.

Mr. WAXMAN. Mr. Speaker, I reserve a point of order.

Mr. WAXMAN. Mr. Speaker, on that I demand the yeas and nays.

Mr. WAXMAN. Mr. Speaker, I withdraw my reservation, and I rise in opposition to the motion to recommit.

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

Mr. WAXMAN. Mr. Speaker, pursuant to the instructions of the House in the motion to recommit, I report the bill, H.R. 5019, back to the House with an amendment.

Mr. WAXMAN

Mr. WAXMAN. Madam Speaker, I rise to congratulate the El Camino Real High School Academic Decathlon team on its extraordinary record-setting sixth victory as the United States Academic Decathlon champions. I am extremely proud to represent this remarkable team of nine students of Woodland Hills, California. The students committed months of hard work together in preparation for this competition. The nationwide competition is very challenging and includes written and oral tests in seven subjects. The team set a record with its sixth United States Academic Championship and defeated 34 teams from around the country. They received an astounding 49,951.7 points out of a possible 60,000 and won and impressive 21 individual awards. The nine winning team members are Vivian Cheng, Daniel de Haas, Evan Edmisten, Andrew Fann, Audrey Goldbaum, Jessica Lin, Daniel Moreh, Adriana Ureche and Michael Walker. The coaches are John Dalsass and Stephanie Franklin. The students personify academic excellence and the power of teamwork. Their dedicated coaches, school, staff, families and entire community are tremendously proud of their achievement. I ask my colleagues to join me in recognizing these remarkable students.

Mr. WAXMAN

Mr. WAXMAN. Madam Speaker, this week, we solemnly commemorate the 95th Anniversary of the beginning of the Armenian Genocide. From 1915 to 1923, the Ottoman Government sought to destroy Armenian communities through a systematic campaign of terror. Men were separated from their families and murdered; women and children were forced to march across the Syrian Desert, and killed if they lagged behind. At the time, the United States took bold diplomatic, political, and humanitarian action to end the bloodshed and protect the survivors. Ninety-five years later, we must continue to take pride in our efforts and reaffirm our commitment to ending genocide and defending human rights for all. Sadly, there still remain those who aggressively deny or raise doubt about this chapter of history. The Republic of Turkey threatens severe diplomatic consequences to nations that officially recognize the genocide, and current Turkish law deems discussion of the genocide to be a criminal offense. Moreover, as a part of negotiations to end its seventeen-year blockade of the modern nation of Armenia, Turkey has insisted on the establishment of a new historical commission to study the events of 1915 to 1923, as if abundant scholarly evidence of genocide did not already exist. If we are to prevent future atrocities, we must not be afraid to speak out about those that have taken place in the past. I am proud to have cosponsored H. Res. 252, which passed the House Foreign Affairs Committee on March 4, 2010. The resolution calls upon the President to ensure that the foreign policy of the United States reflects appropriate understanding and sensitivity of the United States record relating to the Armenian Genocide. That vote--as well as today's somber tribute--reflects our determination to honor the memory of the genocide's victims and leads us to vow, once more, that genocide will never go unnoticed, unmentioned, or unmourned.

Mr. WAXMAN

Mr. WAXMAN. Mr. Speaker, this week, Israel marks the 62nd anniversary of the historic date in the Hebrew calendar when the British Mandate over Palestine expired and a modern Jewish state was reborn. Each year, Israel Independence Day, Yom Ha'atzmaut, is an opportunity to catalogue the remarkable accomplishments of a nation built on the hopes of generations. And it is an opportunity for us to reiterate the enduring support and friendship of the United States government and the American people. This year, we celebrate a country that has engineered immense economic prosperity, even in the face of the worst economic challenge since the Great Depression. Today, Israel has the second largest number of technology startup companies in the world, after the United States. As we mark the 25th anniversary of the 1984 U.S. Free Trade Agreement, Israel boasts the largest number of NASDAQ-listed companies outside of North America. Considering Israeli leadership in bio-medical, alternative energy, and defense research, it is no surprise that Israeli GDP now rivals countries in Europe. Military and intelligence cooperation between the United States and Israel has reached unprecedented levels with operations like the joint missile defense exercise Juniper Cobra, approved sales of sensitive military technology, and regular Israeli participation in NATO patrols of the Mediterranean. In November, I had the honor of attending the dedication of the 9/11 Living Memorial, a monument established by the Jewish National Fund in the foothills of Jerusalem beside a forest planted in the memory of those who perished on 9/11. It is the only memorial outside the United States that names all of the victims and a powerful example of the enduring and emotional connection between our nations. This year, Yom Ha'atzmaut also comes at a moment of great anxiety. Iran is ramping up efforts to obtain nuclear weapons capability which poses an existential threat to the country's survival. Hezbollah is arming itself with Scud missiles. Gilad Shalit remains in captivity. Gaza remains unstable and in the coming months the United Nations General Assembly will again seek action on the flawed, inaccurate, and biased Goldstone Report on the war in Gaza. In the face of all these issues, it is clear that the United States is working side-by-side with Israel to meet and resolve all of these challenges. In the past few weeks, there have been tensions and arguments among good friends. Emotions were high after Vice President Biden's recent visit to Israel. It was distressing that the mishandling of a housing planning announcement tarnished a concrete peace initiative to launch proximity talks designed to facilitate the return to direct negotiations between Israel and the Palestinian Authority. But Israel is not retreating from the road of diplomacy, and neither is the United States. The Palestinian Authority should also stay the course. What is more significant, are the exceptionally strong statements of support for Israel, its security and our alliance by the President, the Vice President, and the Secretary of State's and Prime Minister Netanyahu's reiteration of his commitment to participate in talks, proximity or direct, without pre-conditions. Although Israel's enemies want to portray an atmosphere of crisis, there is nothing for them to exploit. The one-state solution they advocate to eradicate the Jewish state is transparently a policy of genocide not peace. When peace is finally achieved, Jerusalem will remain, as it is today, the eternal capital of Israel. And this will be embraced by the United States in spirit and in law, just as it is today. The most resounding answer to Israeli's critics is the strength and vibrancy of its democracy, its commitment to live in peace with its neighbors, and its dedication to promoting stability and security in the region. The United States and Israel have much common ground to celebrate this year as always and we stand proud to do so.

Mr. WAXMAN

Mr. WAXMAN. Mr. Speaker, I rise in support of H.R. 3125, the Radio Spectrum Inventory Act, which I introduced last year with Chairman Boucher, Ranking Members Barton and Stearns, and more than a dozen of our colleagues on the Energy and Commerce Committee. This timely, bipartisan legislation creates a process for full inventory, mapping, and accounting of current spectrum use by Federal and non-Federal users. This measure will inject transparency in the way our government and the private sector utilizes the critical public resource. With the benefit of this inventory, we can make informed, rational, and deliberate decisions about how our spectrum is used in future decades to benefit the American people, American businesses, and American innovation. It also creates a parallel process for a regular assessment of whether any spectrum should be reallocated or otherwise made available for shared access to improve the efficiency with which we utilize this precious resource. I'm pleased that the bill includes a strong national security section reflecting the result of extensive bipartisan consultation with the defense and intelligence communities. The bill we consider today strikes a proper balance between providing useful information to the public about the nature and use of spectrum, while safeguarding national security, homeland security, and public safety interests. I urge my colleagues to support this important measure.

Mr. WAXMAN

Mr. WAXMAN. Mr. Speaker, regarding spiritual care: The purpose of health care reform has been to ensure that all Americans are covered by affordable, quality insurance. Some of my colleagues have raised concerns about how this impacts Christian Scientists who use certain primary care services that are currently eligible for a medical care tax deduction. Nothing in this health care reform legislation prevents insurance companies from covering care that is currently recognized by the Internal Revenue Service as eligible for a medical care tax deduction through health insurance plans in the Exchanges; nothing in the legislation is intended to have such a prohibition. Nothing in this legislation is intended to minimize or reduce existing provisions in the law that recognizes spiritual care. Individual responsibility: The individual responsibility requirement requires individuals to pay a tax on their individual tax filings or provide information documenting they fulfill the requirements for having essential minimum coverage over the past year. Congress makes the following findings to support this requirement: The individual responsibility requirement provided for in the Patient Protection and Affordable Care Act, and amended by Section 1002 of the Health Care and Education Reconciliation Act, requires individuals either to purchase a minimum level of insurance coverage or to make a payment on one's tax return to help cover the cost of uncompensated care. This requirement is commercial and economic in nature and substantially affects interstate commerce in many ways, including as a result of the following aggregate effects: (1) The requirement regulates activity that is commercial and economic in nature, involving the distribution and consumption of health care services throughout the national economy, and in particular economic and financial decisions about how and when health care is paid for and when health insurance is purchased. Some individuals currently make an economic and financial decision to forego health insurance coverage and self-insure, paying for charges for services directly to the provider and relying on uncompensated care. The decision by individuals not to purchase health insurance has many substantial effects on the national economy, the national marketplace for health insurance, and interstate commerce. In general, individuals who fail to purchase health insurance have a diminished capacity to purchase health care services, and increase overall health care costs. When such individuals inevitably seek medical care, the costs of that care must often be paid for by providers, insured individuals and businesses through higher premiums, or Federal, State, and local governments. The requirement encourages prepayment for services, and affects an individual's decision whether or not to purchase health insurance by imposing penalties on individuals who remain uninsured. Congressional Budget Office, Key Issues in Analyzing Major Health Insurance Proposals, December 2008. (2) The uninsured receive about $86,000,000,000 in health care, of which about $56,000,000,000 is uncompensated. Private spending on uncompensated care is $14,500,000,000, and includes profits forgone by physicians and hospitals. Government spending on uncompensated care is $42,900,000,000, and is financed by taxpayers at both the State and Federal levels. Jack Hadley et al., Covering the Uninsured in 2008: Current Costs, Sources of Payment, and Incremental Costs, Health Affairs, August 25, 2008. (3) Health care received by the uninsured is more costly. The uninsured are more likely to be hospitalized for preventable conditions. Jack Hadley, Economic Consequences of Being Uninsured: Uncompensated Care, Inefficient Medical Care Spending, and Foregone Earnings, Testimony before the Senate Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, May 14, 2003. Hospitals provide uncompensated care of $35,000,000,000, representing on average 5 percent of hospital revenues. Health Affairs, August 25, 2008. (4) Those who have private health insurance also pay for uncompensated care. Medical providers try to recoup the cost from private insurers, which increases family premiums by an average of over $1,000 a year. Families USA, Hidden Health Tax: Americans Pay a Premium, May 2009. (5) The decision to self-insure increases financial risks to households throughout the United States. Sixty-two percent of all personal bankruptcies are caused by illness or medical bills, and a significant portion of medically bankrupted families lacked health insurance or experienced a recent lapse in coverage. David U. Himmelstein et al., American Journal of Medicine, Medical Bankruptcy in the United States, 2007: Results of a National Study, 2009. (6) The national economy loses up to $207,000,000,000 a year because of the poorer health and shorter lifespan of the uninsured. Elizabeth Carpenter and Sarah Axeen, The Cost of Doing Nothing, New America Foundation, November 2008. (7) A large share of the uninsured are offered insurance at low or zero premiums, but choose to forego coverage. New America Foundation, December 6, 2007. According to one estimate, the absence of a requirement from health reform would leave 50 percent of the uninsured without coverage. Linda J. Blumberg and John Holahan, Do Individual Mandates Matter?, The Urban Institute, January 2008. While generous subsidies alone would not achieve universal coverage, the requirement further expands coverage. Congressional Budget Office, December 2008. The requirement improves budgetary efficiency by significantly lowering the federal cost per newly insured. Jonathan Gruber, Covering the Uninsured in the U.S., National Bureau of Economic Research, January 2008. In Massachusetts, where a similar requirement has been in effect since 2007, the share of uninsured declined to 2.7 percent in 2009. Massachusetts Division of Healthcare Finance and Policy. (8) By regulating the decision to self-insure, and expanding coverage, the requirement addresses the problem of free riders who rely on more costly uncompensated care, including access to emergency care required by federal law to be provided even to the uninsured, shifting costs to medical providers, taxpayers, and the privately insured. It will also reduce the cost to the national economy of the lower productivity of the uninsured. The preceding 8 points cite numerous studies and papers which illustrate the extensive evidence that the Patient Protection and Affordable Care Act, as amended by Section 1002 of the Health Care and Education Reconciliation Act, substantially affects interstate commerce. These citations are included in their written entirety for the record.

Mr. WAXMAN

Mr. WAXMAN. Mr. Speaker, earlier this week history was made with the enactment into law of the comprehensive access to quality affordable health insurance for all Americans. Tonight we complete action on this legislation and cement for all Americans their sense of security that they will always be able to afford and access health care for themselves and their families. Since our passage of the underlying legislation last weekend, the American people are beginning to fully appreciate the benefits that we have written into law. When fully implemented, reform will bring 32 million uninsured Americans into the health insurance system, seniors will see immediate help with the cost of their prescription drugs, and people who have preexisting medical conditions will not be denied health insurance or charged more for that insurance. If you lose your job, you will not lose access to health care. Our vote tonight improves on what President Obama signed into law on Tuesday. This includes closing the gap in Medicare prescription drug coverage, including the rebate this year to eligible seniors; improving affordability for those with income up to 400 percent of the poverty level; eliminating the special Medicaid deal for Nebraska; and increasing matching rates to States for the costs of services to newly eligible individuals to 100 percent for the first 3 years of coverage expansions. Increasing Medicaid payments. The rates will be increased for primary care physicians so that new Medicaid beneficiaries will have access to primary care and a greater investment into community health centers. These initiatives are fully funded and paid for. The reconciliation bill reduces the deficit by more than $1 trillion over the next two decades. Health security is a fundamental right for every American, and we remain faithfully committed to that objective. I want to use my time here to give special thanks to our health team on our staff. First of all I want to single out Karen Nelsen, who has been director of the health staff going back to the time I was chairman of the Health and Environment Subcommittee and during the time we were over at the Oversight and Government Reform Committee. With her able assistance, we have Jack Ebeler, Tim Gronniger, Andy Schneider, Purvee Kempf, Brian Cohen, Ruth Katz, Anne Morris, Tim Westmoreland, Stephen Cha, Virgil Miller, Katie Campbell, Bobbie Clark, Sarah Dupres and Naomi Seiler. I want to just close by saying I wish the Republicans would have worked with us instead of fighting this bill every step of the way. They're complaining now they didn't get amendments, but when we called on them to help us, they said no. They wouldn't work with us on the stimulus bill, they wouldn't work with us on the energy bill, they wouldn't work with us on the health bill, but we got it done anyway. Mr. Speaker, the bill is to be commended as a model of cooperative federalism. Under the new law, ``a State is free to establish a health insurance exchange if it so chooses. But if it declines, the Secretary will establish an exchange.'' This is a strong example of what the Supreme Court has recognized as an appropriate exercise of federal power to encourage State participation in important federal programs. ``[W]here Congress has the authority to regulate private activity under the Commerce Clause, we have recognized Congress' power to offer States the choice of regulating that activity according to federal standards or having state law pre-empted by federal regulation. Hodel v. Virginia Surface Mining & Reclamation Assn., Inc., supra, 452 U.S., at 288, 101 S.Ct., at 2366. See also FERC v. Mississippi, supra, 456 U.S., at 764- 765, 102 S.Ct., at 2140. This arrangement, which has been termed ``a program of cooperative federalism,'' Hodel, supra, 452 U.S., at 289, 101 S.Ct., at 2366, is replicated in numerous federal statutory schemes.'' New York v. United States, 505 U.S. 144, 165 (1992). Individual Responsibility The individual responsibility requirement requires individuals to pay a tax on their individual tax filings or provide information documenting they fulfill the requirements for having essential minimum coverage over the past year. Congress makes the following findings to support this requirement, these are in addition to those made on Sunday, March 21, 2010: (1) The requirement is necessary to achieve near-universal coverage while maintaining the current private-public system. It builds upon and strengthens private employer-based health insurance, which covers 176,000,000 Americans nationwide. In Massachusetts, a similar requirement has strengthened employer-based coverage: despite the economic downturn, the number of workers offered employer-based coverage has actually increased. Sharon K. Long and Karen Stockley, Massachusetts Health Reform: Employer Coverage from Employees' Perspective, Health Affairs, October 1, 2009. (2) Under the Patient Protection and Affordable Care Act, if there were no requirement, many individuals would wait to purchase health insurance until they needed care. Those individuals would then get the benefit of the lower premiums that are a direct result of the Act's reforms, even though those lower premiums result in part from the fact that other younger and healthier people bought insurance at an earlier point. Higher-risk individuals would be more likely to enroll in coverage, increasing premiums and costs to the government. The Urban Institute, January 2008. The requirement will broaden the private health insurance risk pool to include healthy individuals, which will spread risk, stabilize the market, and lower premiums. Congressional Budget Office, An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act, November 30, 2009. It is necessary to create effective private health insurance markets throughout the country in which improved health insurance products that are guaranteed issue and do not exclude coverage of pre-existing conditions can be sold. (3) Administrative costs for private health insurance, which were $90,000,000,000 in 2006, are 26 to 30 percent of premiums in the current individual and small group markets. Congressional Budget Office, December 2008. The requirement is necessary to create effective private health insurance markets throughout the country that do not require underwriting, eliminating its associated administrative costs. By significantly increasing health insurance coverage and the size of purchasing pools, which will increase economies of scale, the requirement, together with the other provisions of the Patient Protection and Affordable Care Act, will significantly reduce administrative costs and lower health insurance premiums. (4) Health insurance and health care services are a substantial part of the national economy. National health spending is projected to increase from $2,500,000,000,000, or 17.6 percent of the economy, in 2009 to $4,700,000,000,000 in 2019. Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Expenditure Projections, 2008-2018. Private health insurance spending is projected to be $854,000,000,000 in 2009, and pays for medical supplies, drugs, and equipment that are shipped in interstate commerce. Centers for Medicare & Medicaid Services, Office of the Actuary. Since most health insurance is sold by national or regional health insurance companies, health insurance is sold in interstate commerce and claims payments flow through interstate commerce. (5) The requirement, together with the other provisions of the Patient Protection and Affordable Care Act, will add more than 30,000,000 consumers to the health insurance market. Congressional Budget Office, Patient Protection and Affordable Care Act, Incorporating the Manager's Amendment, December 19, 2009. In doing so, it will increase the demand for, and the supply of, health care services. According to one estimate, the use of health care by the currently uninsured could increase by 25 to 60 percent. Congressional Budget Office, December 2008. (6) Under the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Patient Protection and Affordable Care Act, the Federal Government has a significant role in regulating health insurance. The requirement is an essential part of this larger regulation of economic activity, and the absence of the requirement would undercut Federal regulation of the health insurance market. (7) Payments collected from individuals who fail to maintain minimum essential coverage will contribute revenue that will help the Federal government finance a reformed health insurance system that ensures the availability of health insurance to all Americans. The preceding 7 points cite numerous studies and papers which illustrate the extensive evidence that the Patient Protection and Affordable Care Act, as amended by Section 1002 of the Health Care and Education Reconciliation Act, substantially affects interstate commerce. These citations are included as hyperlinks or in their written entirety for the record.

Mr. WAXMAN

Mr. WAXMAN. I would like to ask unanimous consent that all Members have 5 days in which to revise and extend their remarks and insert extraneous material in the Record.

Mr. WAXMAN. Madam Speaker, I yield 1 minute to the majority leader of the House of Representatives, the gentleman from Maryland (Mr. Hoyer).

Mr. WAXMAN. Madam Speaker, I yield myself 2 minutes. Today is a historic moment. We will take decisive votes to provide quality affordable health care for all Americans. This is a goal that Presidents of both parties have sought for 100 years. We must act. The status quo is unsustainable. This bill provides all Americans the security of knowing they will always be able to afford health care for themselves and their families. The bedrock foundation of the legislation is that it builds on what works today and reforms what doesn't, but we fundamentally reform the insurance company practices that are failing our families. Americans with preexisting conditions can no longer be denied coverage. We abolish lifetime limits on coverage. And we ban the practice of rescission by insurance companies when people get sick. We strengthen Medicare. Seniors who hit the donut hole for their drug coverage will get immediate help, a $250 rebate this year, a 50 percent discount on their brand name drugs next year, and the donut hole will be completely eliminated within the decade. We provide coverage to 32 million uninsured Americans. We eliminate waste, fraud, and abuse. The American people will see immediate benefits. Today we vote to make a profound difference for the betterment of the American people. Under the leadership of the President and our Speaker, we are poised to provide access to quality health insurance for all. Today is a historic moment. We will take decisive votes to provide quality, affordable health care to all Americans. This is a goal that Presidents of both parties have sought for a hundred years. We must act. The status quo is unsustainable. This bill provides all Americans the security of knowing they will always be able to afford health care for themselves and their families. The bedrock foundation of this legislation is that it builds on what works today, and reforms what doesn't. If you like your doctor and your current plan, you keep them. But we fundamentally reform the insurance company practices that are failing our families: Americans with pre-existing conditions can no longer be denied coverage. We abolish lifetime limits on coverage. And your health coverage can no longer be rescinded by your insurance company if you get sick. We strengthen Medicare. Seniors who hit the donut hole will get some immediate help: a $250 rebate this year, and a 50 percent discount on their brand-name drugs next year. And the donut hole will be completely eliminated within a decade. We provide coverage to 32 million uninsured Americans--not just those without insurance today but many who would otherwise be expected to lose their coverage in the coming years. We eliminate waste, fraud, and abuse and reduce the deficit by over a trillion dollars. And we eliminate the special deal for Nebraska, providing all states equitable treatment under Medicaid. The American people will see immediate benefits on enactment. Starting this year: Your children can stay on your policy through age 26. Preventive care under Medicare is free. And children with pre-existing conditions cannot be denied coverage. Today we vote to make a profound difference for the better for the American people. Under the leadership of the President and our Speaker, we are poised to provide access to quality health insurance for all Americans. I now want to turn to some specific provisions in the Senate bill, H.R. 3950. Section 2304. Clarification of definition of medical assistance Section 2304 of H.R. 3590 as passed by the Senate clarifies the definition of medical assistance. This clarification is identical to that in section 1781(e) of H.R. 3962 as passed by the House and in section 1781(e) of H.R. 3200 as reported by the Committee on Energy and Commerce. The purpose of this clarification is set forth in H. Rept. 111-299, Part 1, at pp. 649-650. Section 3301. Medicare coverage gap discount program I, on behalf of myself and Chairman Levin, express our intent regarding this section. Section 3301 of this legislation provides for 50 percent discounts for brand name drugs in the Part D donut hole. It requires that manufacturers enter into an agreement to provide such discounts as a condition of participation in the Part D program. This section adds to the Social Security Act new Section 1860D- 43(c)(1), which provides a limited exemption from the requirement to provide a discount if the Secretary makes a determination that the availability of the drug is essential to the health of beneficiaries under this part. This intent of this exemption, if it is used at all, is that it be used only in extraordinary circumstances, and that it be of limited duration. For example, if a new drug manufacturer without an agreement already in place receives a new drug application approval after the period in which annual agreements are supposed to be signed by the Secretary, the Secretary could find that the drug is essential to beneficiaries' health and provide a short-term exemption until an agreement with the manufacturer is in place. Any exemptions provided under this section are intended to be temporary in nature. Moreover, nothing in this section requires the Secretary to make a finding that a given drug is essential to beneficiaries' health, or provides a right of action for any individual or organization to force the Secretary to make such a finding. This provision also contains civil monetary penalties for manufacturers that fail to provide applicable beneficiary discounts. The civil monetary penalties specified in this provision are not the sole penalties that can be applied to manufacturers that violate requirements of this section or other provisions of law. For example, relevant CMPs that apply to Medicare fraud or misleading statements and False Claims Act penalties can also be applied to manufacturers that fail to provide required discounts. Another provision of this section states that the Secretary ``shall not receive or distribute any funds of a manufacturer under this program''. This provision refers only to manufacturer funds, not to other funds or information. Section 1860D-43 contains no restriction on the ability of the Secretary, CMS, or the Inspector General to obtain (from any manufacturer, PDP or MA-PD plan, or other entity) any data or information necessary for the purposes of program compliance and integrity or audit purposes, or otherwise necessary to identify and eliminate waste, fraud, or abuse under this section. Section 3403. Independent Medicare Advisory Board I wish to clarify certain aspects of legislative intent regarding the Independent Payment Advisory Board (IPAB), which is a new executive branch body created in the Senate passed health reform bill and charged with constraining Medicare spending. Section 1899A(c)(2)(A)(iii) of the Social Security Act, as added by Section 3403 of PPACA, states that in the case of IPAB proposals submitted prior to December 31, 2018, IPAB shall not include any recommendations that would reduce payment rates for providers that receive an additional market basket cut on top of the productivity adjustment. The rationale for this provision is that these providers are already facing extra downward adjustments in their payments and thus should not be subject to ``double jeopardy'' by also being subject to IPAB recommendations which will further reduce spending. In creating this exclusion, it is the intent of Congress to exclude all payment reductions applicable to providers captured by this language in all the relevant years. Therefore, in the case of inpatient hospitals, the provision excludes from IPAB recommendations payment reductions applicable to hospitals including payment reductions for indirect medical education under 1886(d)(5)(B), graduate medical education under 1886(h), disproportionate share hospital payments under 1886(d)(5)(F), and capital payments, as well as incentives for adoption and maintenance of meaningful use of certified electronic health record technology under 1886(n). As part of the effort to make improvements to the Senate-passed bill, Members of the House and Senate, along with the administration, were working on a number of improvements to the IPAB policy. Unfortunately, the Senate parliamentarian indicated that we could not modify IPAB in reconciliation. Since we were not able to make any changes to the IPAB as part of the reconciliation bill, I look forward to working on these improvements in the future. Section 3512 I have spoken with several Members, including Congressman Cuellar of Texas, that have expressed concerns about whether the language of these bills may be interpreted or construed as creating a new cause of action or claim or would modify or impair existing state medical malpractice laws. It is not and never has been the intent of this legislation to create any new causes of action or claims premised on the development of guidelines or other standards. Section 10201(j) of H.R. 3590, which was part of a manager's amendment adopted on the Senate floor and added Section 3512 to Subtitle F of title III of the Act, calls for the Comptroller General to conduct a study of whether the development, recognition or implementation of any guideline or other standards under a list of enumerated sections of the Senate bill would result in a new cause of action or claim. Any guideline or standard created under the above enumerated sections should not be construed as creating any such new actions or claims, nor should the request for a study be construed to infer otherwise. This legislation should not be interpreted or construed as creating any inference or implication that any such guideline or other standard does create any new cause of action or claim. It is also not and never has been the legislative intent of this legislation to modify, impair or supersede any State medical liability law governing legal standards or procedures used in medical malpractice cases, and this legislation does not have the authority to prohibit the states from implementing such laws. Section 6111. Civil Money Penalties The legislation we will pass today contains nursing home reforms that will make it easier to identify owners responsible for inadequate care, improve enforcement, and improve nursing home quality nationwide. These improvements represent a significant step forward. Nearly identical provisions were included in health care reform legislation that passed in the Energy and Commerce Committee, and in HR 3200 as passed by the House. Section 6111 of the legislation makes collection of civil monetary penalties more timely by allowing funds to be escrowed after an independent informal dispute resolution process until other appeals are concluded. A November 2009 GAO report found that understatement of deficiencies may result from ``unbalanced'' independent dispute resolution processes currently used. Over 40 percent of surveyors in four states told GAO that their states' independent dispute resolution processes favored nursing home operators over resident welfare. In order to avoid these problems, the intent of this section is that independent informal dispute resolution processes should be conducted by an independent state agency or entity with healthcare experience, or by the state survey agency, so long as no entity or individual who conducts independent informal dispute resolution has a conflict of interest. The Secretary's implementing regulations may address the type and duration of the independent informal dispute resolution processes. as determined by the Secretary. As under current law, facilities may challenge only the factual basis of the deficiency; and states and the Secretary retain the right to reject independent informal dispute resolution processes recommendations, any person shall have the right to attend and participate in the conference. I reserve the balance of my time.

Mr. WAXMAN. Madam Speaker, I am proud at this time to yield 2 minutes to the gentleman from Michigan (Mr. Dingell), the distinguished dean of the House, who has championed the cause of health care in all of the time he has been in the Congress. And before that, his father called upon the Congress to adopt this legislation as well. (Mr. DINGELL asked and was given permission to revise and extend his remarks.)

Mr. WAXMAN. Madam Speaker, I am pleased to yield at this time to the chairman of the Health Subcommittee, who has played such an instrumental role in the legislation, the gentleman from New Jersey (Mr. Pallone) for 1 minute.

Mr. WAXMAN. Madam Speaker, I yield 1 minute to the gentleman from Massachusetts (Mr. Markey), a very important member of our committee.

Mr. WAXMAN. Madam Speaker, I'm honored at this time to yield 1 minute to a senior member of our committee, the gentlewoman from California (Ms. Eshoo).

Mr. WAXMAN. Madam Speaker, I yield for a unanimous consent request to the gentlelady from the Virgin Islands (Mrs. Christensen), who's played a very active role in this legislation. (Mrs. CHRISTENSEN asked and was given permission to revise and extend her remarks.)

Mr. WAXMAN. Madam Speaker, I yield 1 minute to the gentleman who's played a very influential role in this legislation, the gentleman from Michigan (Mr. Stupak).